Malignant non-Hodgkin's lymphoma : Current classification and biopsy diagnostics

Objective: Imaging plays a central role in the staging and biopsy-based diagnosis of malignant lymphomas. The diagnostic approach using core needle biopsy requires an interdisciplinary strategy that integrates clinical, histopathological and molecular characteristics of non-Hodgkin's lymphomas (NHL).

Methods: Ultrasound and/or computed tomography (CT)-guided biopsy. The current WHO classification defines over 40 non-Hodgkin's lymphoma entities, taking the genomic heterogeneity into account. This review focuses on non-Hodgkin's lymphomas with imaging-based diagnostic relevance, including indolent and aggressive B‑NHL as well as systemic T/NK-NHL. It also discusses technical aspects of core needle biopsy and treatment-related effects that can impact the biopsy quality. Special attention is paid to the role of imaging and biopsy techniques in detecting high-grade transformation of indolent B‑NHL, which is associated with rapid progression and diagnostic challenges.

Conclusions: Ultrasound-guided and CT-guided core needle biopsies are well-established standard procedures with a high sensitivity. Close interdisciplinary collaboration between radiology and pathology, along with structured communication of clinical information are essential to ensure high diagnostic accuracy.