Diagnosis of follicular lymphoma of the gastrointestinal tract: A better initial diagnostic workup

Table 1 Initial diagnostic workup for patients with primary or secondary gastrointestinal involvement of follicular lymphoma

Required evaluations

Performance status

Physical exams of the peripheral lymph nodes, liver, spleen, and Waldeyer’s ring.

Blood tests including a complete blood count and leukocyte differential, LDH, β2-microglobulin, uric acid, creatinine, electrolytes including calcium and phosphate, liver function tests, albumin, and serology tests for hepatitis B, C, and HIV.

Immunoglobulins and electrophoresis of proteins

Esophagogastroduodenoscopy, colonoscopy, and enteroscopy1

PET-CT scanning of the neck, chest, abdomen, and pelvis

Chest X-ray, abdominal ultrasound

Bone marrow biopsy

When planning chemotherapy: electrocardiogram, cardiac ultrasound2, creatinine clearance

Optional

sIL-2R

Helicobacter pylori test

Magnetic resonance imaging of the CNS3

Flow cytometry, FISH/PCR for BCL-2 rearrangement of the bone marrow cells

Reproductive counseling to preserve fertility before chemotherapy

¹Required when planning radiotherapy. Video capsule enteroscopy and/or balloon assisted enteroscopy.

²Required before chemotherapy with anthracycline-based regimens or autologous stem cell transplantation.

³Required only for patients with suspected CNS involvement. HIV: Human immunodeficiency virus; CNS: Central nervous system; sIL-2R: Soluble interleukin-2 receptor; CT: Computed tomography; PET: Positron emission tomography; FISH: Fluorescence in situ hybridization; PCR: Polymerase chain reaction; LDH: Lactate dehydrogenase; BCL-2: B-cell lymphoma 2.