Mandatory medical device diagnostics.
- Computed tomography (CT; cross-sectional imaging procedure (X-ray images from different directions with computer-based evaluation) with contrast medium of neck, thorax/mediastinum (mediastinal space, is a vertically running tissue space in the thoracic cavity) (thoracic CT), abdomen (abdominal CT) – for staging (stage determination) or treatment planning.
- X-ray of the thorax (X-ray thorax / chest), in two planes – to assess the lungs.
- Positron emission tomography/computed tomography (PET-CT (combined nuclear medicine (PET) and radiology (CT) imaging technique in which the distribution pattern of radioactive substances (tracers) can be localized very precisely using cross-sectional imaging) [S3 guideline].
- For initial staging or determination of disease activity.
- If necessary, also to find PET-positive lymph nodes for further histological evaluation.
- For detection of bone marrow involvement [if detection negative: no bone marrow biopsy]Note: When excluding bone marrow involvement on PET/CT, a bone marrow biopsy should be omitted.
- For individual decision – e.g. in young patients – in case of a negative PET/CT, the benefit of consolidative radiotherapy can be weighed against the potential secondary malignancy risk.
- When planning involved-site radiotherapy (= radiotherapy to the affected or “involved” tissue; IF = “involved field” radiotherapy).
- For de-escalation (cut back standard chemotherapy), if after the first two cycles in PET no tumor cells are visible; to avoid lung damage (severe pneumonitis / collective term for any form of pneumonia (pneumonia), which does not affect the alveoli (alveoli), but the interstitium or the intercellular space) by the cytostatic drug bleomycin.
- After chemotherapy completion: PET/CT after therapy is used to assess the individual response to chemotherapy.
- For recurrence diagnostics (to diagnose the recurrence of the tumor): diagnostic CT (computed tomography) with contrast medium and a PET-CT.
- For clarification of a remission status after autologous transplantation (self-donation).
- Sonography (ultrasound examination) – for the investigation of clinically suspicious extranodal affections ((outside lymph nodes) or organ affections.
- Magnetic resonance imaging (MRI; computer-assisted cross-sectional imaging (by means of magnetic fields, that is, without X-rays) – for the examination of clinically suspicious extranodal affections or organ affections.
Optional medical device diagnostics – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification.
- X-ray of skeletal parts and/or bone scintigraphy – if bone involvement is suspected.
- Encephalogram (EEG; recording of the electrical activity of the brain) – if brain involvement is suspected.
Laboratory tests recommended prior to initiation of chemotherapy (due totoxicity):
- Electrocardiogram (ECG; recording of the electrical activity of the heart muscle).
- Echocardiography (echo; heart ultrasound).
- Spirometry (lung function)
- Gonadal function (fertility protective measures see below prevention).
