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.