In high-income countries (HICs), diagnosis and classification of lymphoma incorporates detailed phenotypic and genetic data with morphologic evaluation. This precise classification guides both prognosis and the selection of therapy. In contrast, detailed subtyping in lower/middle-income countries (LMICs) is largely lacking. Immunohistochemistry, fluorescence in situ hybridization (FISH), and molecular assay capabilities are almost completely absent from LMICs. This lack of comprehensive lymphoma subtyping derives partially from inadequate numbers of pathologists and the high cost of precision diagnostics.
The Weinstock laboratory at Dana-Farber recently demonstrated that gene expression assays, which can be performed on paraffin-embedded tissue at low cost, can be used to make specific lymphoma diagnoses without the use of IHC or other pathology approaches (Morgan et al. Blood Advances 2016 [in press]). This improvement in pathologic classification would not only ensure appropriate application of currently available therapies, but also identify patients suitable for treatment with less toxic, targeted therapies should they be implemented in the future.