Fast Five Quiz: Management of Mantle Cell Lymphoma

Elwyn C. Cabebe, MD; Ann S. LaCasce, MD, MMSc


January 26, 2023

According to 2022 guidelines from the National Comprehensive Cancer Network (NCCN), an incisional or excisional lymph node biopsy is recommended to establish the diagnosis of any B-cell lymphoma, including MCL. In general, fine-needle aspiration biopsy alone is not sufficient for the initial diagnosis of lymphoma, and studies have shown that its diagnostic accuracy is significantly improved when it is used in combination with immunohistochemistry (IHC) and flow cytometry.

The same guidelines state that these components are essential in the workup for MCL:

  • A complete physical exam, with particular attention to node-bearing areas and the size of liver and spleen, symptoms, and performance status

  • Laboratory studies, including complete blood count (CBC), serum lactate dehydrogenase (LDH), hepatitis B virus (HBV) testing, and comprehensive metabolic panel

  • PET/CT

  • Chest/abdominal/pelvic CT with oral and intravenous contrast (unless if renal insufficiency exists) if PET/CT is not available

  • Multigated acquisition (MUGA) scan or echocardiograms when anthracyclines and anthracenedione-containing regimens are used

PET/CT is recommended for the initial staging and restaging of all FDG-avid lymphomas. PET/CT is particularly important for staging before consideration of radiation therapy, and baseline PET/CT helps in the assessment of posttreatment response evaluation.

Rarely, patients may present with limited stage I/II disease. In such cases, gastrointestinal endoscopy and bone marrow biopsy are essential to confirm disease stage.

Learn more about the workup for MCL.


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