With a focus on the pathology aspects of diagnosing lymphoma, the American Society for Clinical Pathology (ASCP), the American Society of Hematology (ASH), and the College of American Pathologists (CAP) are collaborating to develop an evidence-based clinical practice guideline for the workup of lymphoma.

According to a joint press release from the associations, the impetus for the new guideline stems from medical practitioners being challenged to diagnose lymphoma using samples of decreasing tissue volume, including fine-needle aspirations and needle biopsies. At the same time, the associations note, increasingly complex diagnostic criteria require the performance of more ancillary tests in order to differentiate specific subtypes of lymphoma, so that the patient’s therapy can be optimized.


Steven H. Kroft, MD, Medical College of Wisconsin.

In response to such challenges, an interdisciplinary panel of experts representing the organizations is developing the guideline. The expert panel includes clinical oncologists, pathologists, and patient representatives. A review draft of the guideline, “Requirements for Laboratory Workup of Lymphoma,” is available for public comment now through October 24, 2018.1

“Diagnosis and classification of lymphoma has become a highly complex, multimodality process that requires rigorous attention to and quality assurance of preanalytical, analytical, and postanalytical details,” says Steven H. Kroft, MD, ASCP cochair of the expert panel.

“At the same time, clinical practice has evolved to favor the least-invasive possible procedures to secure diagnoses. Thus, pathologists are being asked to do more and more with less and less,” continues Kroft. “However, little guidance exists regarding the appropriate handling, testing, and reporting of lymphoma specimens. This guideline will assist pathologists and clinicians in making good decisions about the workup of lymphoma, so as to best serve our patients and enable optimal outcomes.”


Cordelia E. Sever, MD, University of New Mexico.

All stakeholders—including clinicians, hematologists/oncologists, hospitals or health systems, laboratory personnel, quality managers in laboratories,  pathologists, pathologists’ assistants, patients, patient advocacy group representatives, and vendors—are encouraged to provide feedback on the draft recommendations.

“It is our hope that an open comment period draws input from diverse practice settings beyond the diversity represented in the expert panel,” says Cordelia E. Sever, MD, CAP cochair of the panel. “This input usually provides information on common practice, as well as particular practice settings that were not obvious in the drafting stage of the guideline. Incorporating the feedback will strengthen the final guideline and make it universally applicable.”

The panel has drafted 14 evidence-based recommendations, primarily addressing the preanalytic phase of testing, with an emphasis on specimen requirements. Specimens to investigate suspected lymphoma require special handling, the expert panel notes, and these handling decisions are best planned in advance in consultation with the pathologist or following agreed-upon institutional protocols.

The expert panel reviewed more than 6,000 peer-reviewed articles with the aim of answering the overarching clinical question, ‘What are the specimen requirements for accurate diagnosis of patients in whom lymphoma is being considered?’


Matthew Cheung, MD, Sunnybrook Health Sciences Center.

“A primary goal of this guideline would be to provide evidence-based recommendations for the preanalytic phase of testing, with a focus on specimen requirements,” says Matthew Cheung, MD, ASH cochair of the expert panel. “A secondary goal would be to provide evidence-based guidance on which ancillary testing and clinical parameters would contribute to diagnostic certainty in circumstances, in particular when additional sampling is not possible or associated with risk to patient safety. Optimal answers to key questions would guide users toward appropriate tissue sampling for common scenarios, and inform which circumstances should prompt a tissue-handling consultation prior to collection of the sample.”

Following the open comment period, the guideline authors will consider all feedback to finalize the recommendations. The final recommendations will be available in the guideline manuscript and will be available at no cost.

To read and comment on the draft guidelines, visit “Requirements for the Laboratory Workup of Lymphoma.”


  1. Requirements for the Laboratory Workup of Lymphoma [review draft, online]. Chicago: American Society for Clinical Pathology; Washington, DC: American Society of Hematology; Northfield, Ill: College of American Pathologists; 2018. Available at: https://app.keysurvey.com/f/1332118/1741. Accessed September 27, 2018.