Ann Arbor Staging Classification

* E: Involvement of a single, extranodal site contiguous or proximal to a known nodal site.

Additional Information

Score Description

The Ann Arbor Staging classification is a staging system for lymphomas. The original Ann Arbor staging system was published in 1971. The subsequent “Cotswold modification” of 1989 extended the definitions of stage IV disease, and added the suffix “X” for bulky disease. It was initially developed for Hodgkin’s disease but is now also widely used in non-Hodgkin lymphomas.


Stage Definition
I Involvement of a single lymph node region or lymphoid structure (e.g. spleen, thymus, Waldeyer ring)
II Involvement of two or more lymph node regions on the same side of the diaphragm (the mediastinum is a single site; hilar lymph nodes are lateralized); the number of anatomic sites should be indicated by suffix (e.g. II3)
III Involvement of lymph node regions or structures on both sides of the diaphragm
​III1 With or without splenic, hilar, celiac or portal nodes
​III2 With paraaortic, iliac or mesenteric nodes
IV Diffuse or disseminated involvement of one or more extralymphatic organs or any involvement of the liver, bone marrow, pleura or cerebrospinal fluid
S is used if the disease is spread to the spleen
A or B: the absence of constitutional (B-type) symptoms is denoted by adding an A to the stage; the presence is denoted by adding a B to the stage
E: Involvement of a single, extranodal site contiguous or proximal to a known nodal site (stages I to III only; additional extranodal involvement is stage IV)
X is used if the largest deposit is > 10 cm large («bulky disease»), or whether the mediastinum is wider than 1/3 of the chest on a chest-X-ray

Further Reading

Carbone PP et al. Report of the Committee on Hodgkin's Disease Staging Classification. Cancer Res. 1971 Nov;31(11):1860-1.