Lugano Classification

* Tonsils, Waldeyer's ring and spleen are considered nodal.

Additional Information

Score Description

The Lugano classification is a revised staging system for primary nodal lymphomas and modification of the Ann Arbor classification. The staging system was developed following workshops held at the International Conference on Malignant Lymphoma in Lugano, Switzerland, and was published 2014. In comparison to the Ann Arbor classification the Lugano classification proposed further revisions to clarify the role of positron emission tomography (PET) and better define extranodal involvement. 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 a single suffix («X») to denote bulky disease in the Cotswold modifcations of the Ann Arbor system, the largest tumor diameter is recorded.


Stage Nodal extent Extranodal extent (add suffix E if present)
I One node or a group of adjacent nodes Single extranodal lesion with no nodal involvement
II Two or more lymph node regions on the same side of the diaphragm Stage I or II by nodal extent with contiguous extranodal extension
IIbulky As for II with bulky disease Not applicable
III Nodes on both side of the diaphragm or nodes above the diaphragm with splenic involvement Not applicable
IV Non-contiguous extranodal involvement Not applicable

Note: Extent of disease is determined by positron emission tomography-computed tomography for avid lymphomas and computed tomography for nonavid histologies. Tonsils, Waldeyer's ring and spleen are considered nodal.

For Hodgkin lymphoma only, add Suffix A or B:

A: Absence of constitutional symptoms
B: Constitutional symptoms: Fever > 38°C, drenching sweats, weight loss (10% body weight over 6 months)

Further Reading

Cheson B et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014 Sep 20;32(27):3059-68.