Tests to diagnose non-Hodgkin lymphoma

You usually have a number of tests to diagnose non-Hodgkin lymphoma (NHL). If you have NHL, these test results help your doctors find out what type and stage Open a glossary item of NHL you have. They also help them decide what treatment you need.

The tests include:

  • a lymph node biopsy Open a glossary item
  • blood tests
  • x-rays and scans

Tests your GP might do

Most people with symptoms start by seeing their GP. Your GP might do some tests to help them decide if you need to see a specialist. These tests include:

  • blood tests
  • a physical examination

Depending on the results of your examination and blood tests, your GP may also arrange for you to have other tests. For example, an x-ray or ultrasound scan. You usually have these tests at your local hospital. 

Blood tests

Blood tests can check your general health including:

  • how well your liver and kidneys are working
  • the number of blood cells in your blood such as platelets Open a glossary item and red blood cells  Open a glossary item

Physical examination

Your doctor usually asks you to lie or sit down. They look at and feel your skin and check for any abnormalities or areas that are swollen. Things they look for include signs of bleeding, bruising and infection.

They may also listen to your chest and tummy (abdomen) to find out if they sound normal.

You can ask for someone else to be in the room with you if you want, to act as a chaperone. A chaperone is a trained healthcare professional such as a nurse. A friend or relative can also stay with you for support. They can be with you during the examination. 

Tests your specialist might do

Depending on your symptoms and the results of your blood tests, your GP might arrange for you to go to the hospital. 

The specialist you see at the hospital is called a haematologist. This is a doctor who specialises in diseases of the blood such as lymphoma.

Your specialist usually repeats the blood tests done by your GP. You also have more tests. These might include:

  • testing your lymph nodes for NHL - this is a lymph node biopsy
  • scans such as PET-CT scan Open a glossary item, CT scan Open a glossary item, and an ultrasound scan Open a glossary item
  • a bone marrow test Open a glossary item
  • a lumbar puncture Open a glossary item
  • tests to check for infection

Testing your lymph nodes

The most common symptom of NHL is one or more swollen lymph nodes Open a glossary item.

The main test to diagnose NHL is a lymph node biopsy. A doctor removes part or all of the swollen lymph node. They send it to the laboratory for a specialist to look at it under a microscope.

How you have a lymph node biopsy

This depends on where the swollen lymph node is.

You often have a local anaesthetic Open a glossary item which means you are awake. But you might have a general anaesthetic Open a glossary item if the lymph node is deeper inside your body. This means that you are asleep and do not feel anything.  

The doctor might use a CT scan or ultrasound scan to guide them to the exact place to take the biopsy from. So you might hear this test called an ultrasound guided biopsy or a CT guided biopsy.

Your doctor might take a sample of tissue from the lymph node using a needle. This is called a needle biopsy or a core biopsy. You usually have this under local anaesthetic in the radiology department.

Or your doctor might remove a whole lymph node. This is called an excisional biopsy. You have the biopsy under local or general anaesthetic. It is a small operation that most people have as a day case.

Your doctor might also need to take biopsies from other parts of your body. This depends on where the suspected lymphoma is. They might do:

  • an endoscopy Open a glossary item to take a biopsy from your stomach
  • bronchoscopy Open a glossary item to take a biopsy from your lung
  • colonoscopy Open a glossary item to take a biopsy from your bowel


You usually have some scans to find out where the lymphoma is in your body.

PET-CT scan

A PET-CT scan combines a CT scan and a PET scan. PET stands for positron emission tomography. The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal.

The CT scan takes a series of x-rays from all around your body. The computer puts them together to create a 3 dimensional (3D) picture.

PET-CT scans can be useful for some types of NHL. Your doctor will tell you if you need this type of scan. The scan can show:

  • where the lymphoma is in your body (the stage)
  • how well treatment is working

PET scans can show if tissues are actively growing, like cancer. Or if the tissue is an old injury or scar. After treatment, they can show if swollen lymph nodes are scar tissue or lymphoma that has not responded to treatment.

CT scan

A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body.

You might have a CT scan of your chest, tummy (abdomen) or pelvis. The scan shows up any lymph nodes affected by NHL.

MRI scan

MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to create pictures of the inside of body. 

MRI scans can sometimes show up soft tissue more clearly than CT scans. It might give a clearer idea of where the lymphoma is in your body. Your doctor might arrange an MRI scan to look at certain parts of your body, such as your spine or brain.

Ultrasound scan

You might have an ultrasound to look for changes in your lymph nodes, liver or spleen Open a glossary item

An ultrasound scan uses high frequency sound waves to create a picture of a part of the inside of your body.

The ultrasound scanner has a probe that gives off sound waves. The probe looks a bit like a microphone. The sound waves bounce off the organs inside your body, and the probe picks them up. The probe links to a computer that turns the sound waves into a picture on the screen.

Bone marrow test

You may have this test to check whether there are lymphoma cells in your bone marrow Open a glossary item

You usually have this test under local anaesthetic. This means that you are awake but the area is numb.

During a bone marrow biopsy, your doctor or specialist nurse uses a needle to take a sample of bone marrow. They may use a second needle to take out a piece of more solid bone marrow tissue. They usually take these samples from the back of your hip bone.

Diagram showing a bone marrow biopsy

Lumbar puncture

A lumbar puncture is a test to check if lymphoma cells have spread to the fluid circulating around the brain and spinal cord. The fluid is called cerebrospinal fluid (CSF).

You might have a lumbar puncture for certain types of lymphoma that have a higher risk of spreading into the CSF. Or if you have symptoms that suggest the lymphoma might be affecting your brain. 

You normally have this test in the outpatient department. You have it under local anaesthetic, so you will be awake but the area is numb.

Tests to check for infection

NHL and its treatment can weaken your immune system Open a glossary item

You’ll have blood tests to check if you have had or have specific viruses before you start treatment. Some viruses can be linked to NHL. And there is a risk that some viral infections can flare up during treatment.

Infections that your doctor might test for include:

  • human immunodeficiency virus (HIV)
  • hepatitis B virus (HBV)
  • hepatitis C virus (HCV)
  • cytomegalovirus (CMV)
  • Epstein Barr virus (EBV)

You might have tests for other types of infections if you have certain types of NHL. For example they will test you for an infection called helicobacter pylori (H. pylori) if you have a gastric MALT lymphoma.

Other tests you may have

You may have other tests before starting treatment. These include tests to check your heart. This is because some chemotherapy drugs can affect the muscles of the heart. If you’re going to have one of these drugs, you need to have your heart checked before you start treatment. 

Electrocardiogram (ECG)

You might have a recording of the electrical activity of your heart. This test is called an electrocardiogram (ECG). An ECG tells your doctor a bit more about how well your heart is working. It can help the doctor decide if you need further tests.

Echocardiogram or MUGA

An echocardiogram (echo) is an ultrasound of the heart. It uses high frequency waves to create a picture of your heart. Doctors can look at the structure of your heart and see how well it is working.

You might have a test called a multigated acquistion (MUGA) instead. A MUGA is like an echo except you have a radioactive drug injected into your vein. A special scanner takes pictures to see the pumping action of your heart. 


The tests you have help your doctor find out if you have lymphoma, what type it is, and where it is in your body.

This is important because doctors use this information to recommend the best treatment for you.


Coping with a diagnosis of NHL can be difficult. There is help and support available for you and your family.

  • Guidelines for the management of diffuse large B-cell lymphoma
    S Chaganti and others
    British Journal of Haematology 2016. Volume 174, Issue 1, Pages 43-56

  • Guideline for the diagnosis and management of marginal zone lymphomas: A British Society of Haematology Guideline
    R Walewska and others
    British Journal of Haematology, 2024. Volume 20, Issue 1, Pages 86–107

  • Pan-London Haemato-Oncology Clinical Guidelines Lymphoid Malignancies Part 5: Less Common Lymphoid Malignancies
    South East London Cancer Alliance and others
    January 2020

  • Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    H Tilly and others
    Annals of Oncology, 2015. Volume 26, Supplement 5, Pages 116–v125

  • Non Hodgkin's lymphoma : diagnosis and management (NG52)
    National Institute for Health and Care Excellence (NICE), 2016

Last reviewed: 
10 May 2024
Next review due: 
10 May 2027

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