Lymphoma Evaluation
Systematic classification approach
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Lymphoma Classification Approach (WHO 2022)
Lymphoma Classification Approach (WHO 2022): Lymphoma Evaluation → Specimen Assessment → Architectural Pattern → B-cell vs T-cell → B-Cell Lymphoma Subt...
Pathway Overview
9 steps
Algorithm Steps
9 total
01Start 02Action Specimen Assessment
Evaluate adequacy
- Excisional biopsy preferred (architecture)
- Core biopsy acceptable if adequate
- FNA insufficient for initial diagnosis
- Fresh tissue for flow cytometry
- Submit for cytogenetics/molecular
03Decision Architectural Pattern
Follicular vs diffuse vs nodular
- Follicular: FL, nodal MZL, MCL mantle zone pattern
- Diffuse: DLBCL, BL, T-cell lymphomas
- Nodular sclerosing: Classic Hodgkin
- Interfollicular: Some T-cell, AITL
04Decision B-cell vs T-cell
Lineage determination
- CD20, PAX5, CD79a → B-cell
- CD3, CD2, CD5, CD7 → T-cell
- Reed-Sternberg cells: CD30+, CD15+, PAX5 weak
- Consider NK if CD3-, CD56+
05Action B-Cell Lymphoma Subtyping
Major categories
- DLBCL: Large cells, diffuse, CD20+, GCB vs non-GCB
- Follicular: BCL2+, CD10+, grade 1-2 vs 3
- MCL: CD5+, cyclin D1+, SOX11+
- MZL: CD5-, CD10-, CD23-
- Burkitt: Ki-67 ~100%, MYC+
06Action Molecular/Cytogenetics
Required for many diagnoses
- DLBCL: MYC, BCL2, BCL6 FISH for HGBL
- FL: t(14;18) BCL2-IGH
- MCL: t(11;14) CCND1-IGH
- Burkitt: MYC translocation
- AITL: TET2, DNMT3A, RHOA mutations
07Outcome WHO 5th Edition Diagnosis
Integrated diagnosis with all parameters
08Action T-Cell Lymphoma Subtyping
Mature T-cell neoplasms
- PTCL-NOS: Most common, exclusion diagnosis
- AITL: CD10+, PD1+, CXCL13+, TFH markers
- ALCL: CD30+, ALK+ or ALK-
- Adult T-cell: HTLV-1+, CD4+, CD25+
- Mycosis fungoides: Epidermotropism, cerebriform
- Path rejoins step 06Shared downstream outcome
09Action Hodgkin Lymphoma
Classical vs NLPHL
- Classical HL: RS cells CD30+, CD15+, PAX5 weak
- Subtypes: NS (most common), MC, LR, LD
- NLPHL: LP cells ('popcorn'), CD20+, CD45+, CD15-
- EBV in situ hybridization helpful
- Path rejoins step 06Shared downstream outcome
Guideline Source
WHO Classification of Haematolymphoid Tumours 5th Edition
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- WHO 5th Edition recently released - evolving criteria
- Requires flow cytometry, IHC, cytogenetics, molecular
- Grey zone lymphomas challenging
- Some entities need specific molecular markers
- Clinical staging separate from pathologic diagnosis
Applicable Regions
USAUUKEU
AU: eviQ and RCPA guidelines
UK: NICE lymphoma pathways
US: WHO 5th Edition and ICC classification
Version 1Next review: 2027-01-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Lymphoma Classification Approach (WHO 2022)?
The Lymphoma Classification Approach (WHO 2022) is a diagnostic clinical algorithm for Pathology. It provides a structured decision tree to guide clinical decision-making, based on WHO Classification of Haematolymphoid Tumours 5th Edition.
What guideline is the Lymphoma Classification Approach (WHO 2022) based on?
This algorithm is based on WHO Classification of Haematolymphoid Tumours 5th Edition (DOI: 10.1182/blood.2022016867).
What are the limitations of the Lymphoma Classification Approach (WHO 2022)?
Known limitations include: WHO 5th Edition recently released - evolving criteria; Requires flow cytometry, IHC, cytogenetics, molecular; Grey zone lymphomas challenging; Some entities need specific molecular markers; Clinical staging separate from pathologic diagnosis. Individual patient factors may require deviation from these recommendations.
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