Staging DLBCL

DLBCL Ann Arbor staging

  • The Ann Arbor staging system is used to develop rational treatment strategies and is recommended for all non-Hodgkin's lymphomas (Table 3)8
    • This system is based on the number and location of nodal and extranodal regions and takes symptoms into account8

Table 3. Ann Arbor staging system8,*



I Involvement of a single lymph node or of a single extranodal organ or site (IE)
II Involvement of 2 or more lymph node regions on the same side of the diaphragm, or localized involvement of an extranodal site or organ (IIE) and one or more lymph node regions on the same side of the diaphragm
III Involvement of lymph node regions on both sides of the diaphragm, which may also be accompanied by localized involvement of an extranodal organ or site (IIIE) or spleen (IIIS) or both (IIISE)
IV Diffuse or disseminated involvement of one or more distant extranodal organs with or without associated lymph node involvement

*Fever >38°C, night sweats, and/or weight loss >10% of body weight in the 6 months preceding admission are defined as systemic symptoms.
The spleen is considered nodal.

DLBCL Lugano classification

  • The Lugano modification of the Ann Arbor staging classification is recommended for anatomic description of disease extent (Table 4)15
    • This system ignores the absence or presence of disease-related symptoms and allows for other prognostic factors to direct the choice of therapy

Table 4. Lugano modification of the Ann Arbor staging system (2014)15



Extranodal (E) Status


I One node or a group of adjacent nodes Single extranodal lesions without nodal involvement
II Two or more nodal groups on the same side of the diaphragm Stage I or II by nodal extent with limited contiguous extranodal involvement
II bulky II as above with “bulky” disease Not applicable


III Nodes on both sides of the diaphragm; nodes above the diaphragm with spleen involvement Not applicable
IV Additional noncontiguous extralymphatic involvement Not applicable

NOTE: Extent of disease is determined by positron emission tomography-computed tomography (PETCT) for avid lymphomas and computed tomography (CT) for nonavid histologies. Tonsils, Waldeyer’s ring, and spleen are considered nodal tissue.

Whether stage II bulky disease is treated as limited or advanced disease may be determined by histology and a number of prognostic factors.