Waldenstrom Macroglobulinemia (Lymphoplasmacytic Lymphoma): Diagnosis

Approved by the Cancer.Net Editorial Board, 08/2020

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This section describes options for diagnosing Waldenstrom macroglobulinemia. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose Waldenstrom macroglobulinemia:

Blood tests. Blood tests may include a CBC (complete blood count) with a differential (classification of the types of white cells) and an examination of the blood with a microscope. Blood tests can help your doctor diagnose Waldenstrom macroglobulinemia. An increase in IgM can be found by protein electrophoresis, which is a method of separating proteins in the blood with an electric field.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The type of biopsy performed depends on the location of the cancer.

The most common type of biopsy for Waldenstrom macroglobulinemia is either a bone marrow biopsy or a biopsy of the lymph nodes in the neck, under the arms, or in the groin. A biopsy may also be taken from the chest or abdomen while using a computed tomography (CT or CAT) scan to guide the doctor. More information on bone marrow biopsy and a CT scan is below.

Bone marrow aspiration and biopsy. Lymphoma often spreads to the bone marrow, the spongy material in the center of bones where blood cells are produced. A sample of the bone marrow can be important to diagnose Waldenstrom macroglobulinemia, and it can help find out if the cancer has spread.

Bone marrow aspiration and biopsy are similar and often done at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a different needle.

A pathologist then analyzes the sample(s). A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. Doctors generally give a type of medication called local anesthesia beforehand to numb the area. Local anesthesia is an injection that numbs the procedure area. Stronger types of anesthesia can also be used to lessen the pain.

Tests on the biopsy sample may be done to examine proteins on the tumor cells in order to distinguish Waldenstrom macroglobulinemia from other types of B-cell lymphomas. These types of tests are called immunohistochemistry and flow cytometry.

Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tissue sample and/or bone marrow sample to find specific genes, proteins, and other factors unique to the tumor. Molecular tests can also help distinguish Waldenstrom macroglobulinemia from other B-cell lymphomas. Doctors look for a mutation in the MYD88 gene. This mutation is usually found in people with Waldenstrom macroglobulinemia, but some people whose tissue sample has this mutation might have a different lymphoma or other disease.  Other molecular markers are being studied to help guide prognosis and treatment recommendations.

Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, special dyes, called contrast mediums, are given before the scan to provide better detail on the image. Dyes are injected into a patient’s vein or given as a pill or liquid to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye is injected into a patient’s vein.

Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Funduscopic evaluation. This exam of the eye is done by an ophthalmologist. An ophthalmologist is a medical doctor who specializes in eye care. This test looks at the blood vessels of the eye, which may be altered in people with high IgM and increased blood viscosity.

Urine tests. The doctor tests a urine sample to check for abnormal proteins in the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the extent of spread of the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of Waldenstrom macroglobulinemia. Use the menu to choose a different section to read in this guide.