The Lugano Classification

Revised Staging System for nodal non-Hodgkin and Hodgkin lymphomas

1. Determine stage according to sites involved by lymphoma

StageNodal extent*Extranodal extent (add suffix 'E' if present)
IOne node or a group of adjacent nodesSingle extranodal lesion with no nodal involvement
IITwo or more lymph node regions on the same side of the diaphragmStage I or II by nodal extent with contiguous extranodal extension
II bulkyAs for II; definition of 'bulky' depends upon histology**Not applicable
IIINodes on both side of the diaphragm or nodes above the diaphragm with splenic involvementNot applicable
IVNoncontiguous extranodal involvementNot applicable
* Tonsils, Waldeyer's ring and spleen are considered nodal
** ≥ 10 cm for Hodgkin lymphoma, 6 - 10 cm suggested for diffuse large B cell lymphoma, ≥ 6 cm suggested for follicular lymphoma
Adapted from Cheson et al, 20141

2. For Hodgkin lymphoma only, add suffix A or B

SuffixMeaning
AAbsence of constitutional symptoms
BConstitutional symptoms: fever (> 38°C), drenching sweats, weight loss (10% body weight over 6 months)

This staging system for primary nodal lymphomas was developed following workshops held at the International Conference on Malignant Lymphoma in Lugano, Switzerland, and was published in 2014.1

The anatomic description of the extent of disease is similar to that in the Ann Arbor staging system, but A or B suffixes to denote absence or presence of constitutional symptoms are included only for Hodgkin lymphoma and suffixes to denote specific extranodal sites are removed. Instead of the single suffix (‘X’) to denote bulky disease in the Cotswold modifications of the Ann Arbor system, the largest tumor diameter is recorded. Staging by PET-CT is specifically recommended for FDG-avid lymphomas, and CT for non-avid lymphomas. Routine bone marrow biopsy is not recommended for Hodgkin lymphoma or diffuse large B cell lymphoma.

The manuscript also presents revised response criteria.1