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PubMed This is a summary of 13 peer-reviewed journal articles Updated
Oncology

Mapping Your Disease: Diagnosis and Staging

At a Glance

Diffuse Large B-Cell Lymphoma (DLBCL) is optimally diagnosed using an excisional biopsy and staged using a PET/CT scan. Unlike solid tumors, Stage IV DLBCL is highly curable because systemic chemotherapy treats the cancer wherever it has spread through the immune system.

To treat Diffuse Large B-Cell Lymphoma (DLBCL) effectively, your medical team needs a precise “map” of the disease. This process, called staging, involves confirming the exact type of lymphoma and determining where it is in your body. While the word “Stage IV” is frightening in other cancers, it has a very different meaning in lymphoma [1][2].

The Importance of the Right Biopsy

The first step in staging is a biopsy, where a piece of tissue is removed for testing. For DLBCL, the type of biopsy matters:

  • Excisional Biopsy (Gold Standard): This involves removing an entire lymph node. It is the preferred method because it allows pathologists to see the architecture—the way the cells are organized [3][1]. This organization is crucial for distinguishing DLBCL from other similar-looking lymphomas [4].
  • Needle Biopsies (FNA or Core): While easier to perform, these often provide only a small “snapshot” of the tumor [5]. They may miss the architectural patterns or fail to provide enough tissue for advanced genetic tests, such as FISH (Fluorescence In Situ Hybridization), which looks for specific markers like MYC or BCL2 [6][7].

Mapping the Disease: The PET/CT Scan

Once the diagnosis is confirmed, you will likely have a PET/CT scan. This is the standard tool for staging DLBCL because this type of lymphoma is typically “FDG-avid”—meaning it consumes sugar quickly, which shows up as “bright spots” on the scan [8][9].

  • The Process: You will receive an injection of a safe, radioactive sugar (FDG). After waiting for your body to absorb it, you will lie in a scanner that combines the metabolic detail of a PET scan with the anatomical detail of a CT scan [10].
  • Bone Marrow Check: In the past, every patient needed a bone marrow biopsy (using a needle to take a sample from the hip bone). Today, because PET/CT scans are so sensitive, your doctor may be able to skip the bone marrow biopsy if the scan clearly shows whether the marrow is involved [10][11].

The Lugano Staging System

Doctors use the Lugano classification to categorize how far the lymphoma has spread [10].

Stage Description
Stage I Only one lymph node region or one site outside the lymph nodes is involved [10].
Stage II Two or more lymph node regions on the same side of the diaphragm (the muscle separating your chest and abdomen) are involved [10].
Stage III Lymph nodes on both sides of the diaphragm are involved [10].
Stage IV The lymphoma has spread widely into organs outside the lymph nodes, such as the liver, lungs, or bone marrow [10].

Why Stage IV Lymphoma is Different

In solid tumors (like lung or cancer of the colon), Stage IV usually means the cancer is “metastatic” and often incurable. In DLBCL, this is not the case [1].

  • Systemic Success: Because lymphoma is a cancer of the immune system, it naturally travels through the blood and lymph fluid. Chemotherapy is a “systemic” treatment that also travels everywhere the cancer does [12].
  • Curability: Many patients with Stage IV DLBCL achieve a complete remission and are fully cured with standard chemotherapy [1][13]. Your stage helps your doctor choose the right intensity of treatment, but it does not mean the cancer cannot be beaten [2].

If you would like to know more about the specifics of your lab work, refer to Decoding Your Pathology Report.

Common questions in this guide

Why is an excisional biopsy better than a needle biopsy for DLBCL?
An excisional biopsy removes an entire lymph node, allowing pathologists to see the cell architecture. This helps them accurately distinguish DLBCL from other similar-looking lymphomas, whereas a needle biopsy only provides a small snapshot and may miss important details.
What is a PET/CT scan used for in DLBCL?
A PET/CT scan is the standard tool for mapping or staging DLBCL. It uses a safe, radioactive sugar to identify fast-growing lymphoma cells, helping doctors see exactly where the disease is located in your body.
Do I still need a bone marrow biopsy to stage my lymphoma?
Thanks to the high sensitivity of modern PET/CT scans, a bone marrow biopsy is often no longer necessary. If your scan clearly shows whether your bone marrow is involved, your doctor might be able to skip this procedure.
Does Stage IV DLBCL mean the cancer is incurable?
No, Stage IV DLBCL is highly curable with standard treatments. Because lymphoma is a cancer of the immune system, it naturally travels throughout the body, and systemic chemotherapy can effectively reach and treat it everywhere it goes.
What is the Lugano staging system?
The Lugano staging system is used by doctors to categorize how far lymphoma has spread. It ranges from Stage I, where only one lymph node region is involved, to Stage IV, where the lymphoma has spread to outside organs like the liver or lungs.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Why is an excisional biopsy better than a needle biopsy for my specific diagnosis?
  2. 2.Does my PET/CT scan show involvement in any organs outside of my lymph nodes?
  3. 3.Based on my PET/CT results, is a bone marrow biopsy still necessary to complete my staging?
  4. 4.Can you explain what my 'Stage' means for my treatment plan and my chances of a full recovery?
  5. 5.How will we use the 'Deauville scale' to measure my progress during treatment?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (13)
  1. 1

    Diffuse large B-cell lymphoma: 2019 update on diagnosis, risk stratification, and treatment.

    Liu Y, Barta SK

    American journal of hematology 2019; (94(5)):604-616 doi:10.1002/ajh.25460.

    PMID: 30859597
  2. 2

    Genetic and epigenetic determinants of diffuse large B-cell lymphoma.

    Bakhshi TJ, Georgel PT

    Blood cancer journal 2020; (10(12)):123 doi:10.1038/s41408-020-00389-w.

    PMID: 33277464
  3. 3

    Ancillary Studies in the Diagnostic Evaluation of Large B-Cell Lymphoma.

    Cunningham AM, Harrington AM

    Archives of pathology & laboratory medicine 2019; (143(12)):1464-1471 doi:10.5858/arpa.2019-0331-RA.

    PMID: 31584842
  4. 4

    Role of FNA with core biopsy or cell block in patients with nodular lymphocyte-predominant Hodgkin lymphoma.

    Gupta S, Long SR, Natkunam Y, et al.

    Cancer cytopathology 2020; (128(8)):570-579 doi:10.1002/cncy.22286.

    PMID: 32343479
  5. 5

    Transformation of diffuse large B-cell lymphoma to lymphoblastic lymphoma.

    Kushwaha P, Singh M, Mallya V, et al.

    Journal of cancer research and therapeutics 2022; (18(Supplement)):S475-S477 doi:10.4103/jcrt.jcrt_66_21.

    PMID: 36511008
  6. 6

    An increase in MYC copy number has a progressive negative prognostic impact in patients with diffuse large B-cell and high-grade lymphoma, who may benefit from intensified treatment regimens.

    Schieppati F, Balzarini P, Fisogni S, et al.

    Haematologica 2020; (105(5)):1369-1378 doi:10.3324/haematol.2019.223891.

    PMID: 31399522
  7. 7

    The impact of MYC and BCL2 structural variants in tumors of DLBCL morphology and mechanisms of false-negative MYC IHC.

    Collinge B, Ben-Neriah S, Chong L, et al.

    Blood 2021; (137(16)):2196-2208 doi:10.1182/blood.2020007193.

    PMID: 33120427
  8. 8

    A comparison of clinical staging using the Lugano versus Ann Arbor classifications in Japanese patients with Hodgkin lymphoma.

    Makita S, Maruyama D, Maeshima AM, et al.

    Asia-Pacific journal of clinical oncology 2020; (16(3)):108-114 doi:10.1111/ajco.13248.

    PMID: 31802636
  9. 9

    PET/CT in Non-Hodgkin Lymphoma: An Update.

    Zanoni L, Bezzi D, Nanni C, et al.

    Seminars in nuclear medicine 2023; (53(3)):320-351 doi:10.1053/j.semnuclmed.2022.11.001.

    PMID: 36522191
  10. 10

    Revised staging system for malignant lymphoma based on the Lugano classification.

    Munakata W, Terauchi T, Maruyama D, Nagai H

    Japanese journal of clinical oncology 2019; (49(10)):895-900 doi:10.1093/jjco/hyz111.

    PMID: 31504700
  11. 11

    Utility of 18F-fluorodeoxyglucose PET-CT scan in detecting bone marrow involvement in lymphoma.

    Jitani AK, Dutta S, Mandal PK, et al.

    The Indian journal of medical research 2021; (154(5)):691-698 doi:10.4103/ijmr.IJMR_1420_19.

    PMID: 35532587
  12. 12

    Dramatic radiotherapy response in a necrotic lymphoma mass: a case report.

    McNeil N, Gorayski P, Blunt D, Roos D

    Journal of medical case reports 2020; (14(1)):118 doi:10.1186/s13256-020-02438-1.

    PMID: 32718327
  13. 13

    Primary Diffuse Large B-Cell Lymphoma of the Seminal Vesicles: A Rare Case With Diagnostic and Therapeutic Implications.

    Soleimani M, Farajpour M, Kazeminejad B

    Clinical case reports 2025; (13(6)):e70489 doi:10.1002/ccr3.70489.

    PMID: 40438750

This page explains DLBCL diagnosis and staging for educational purposes only. Always consult your oncologist to discuss your specific staging, biopsy results, and personalized treatment plan.

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