Ann Arbor staging

Anatomic staging system for lymphoma based on nodal distribution vs extranodal spread; originally designed for HL and many NHL.

Stages

• Stage I
  • Single lymphatic site (nodal region / Waldeyer ring / thymus / spleen), or
  • Single extranodal site without nodal disease (IE).
• Stage II
  • ≥2 nodal regions on the same side of diaphragm, or
  • Contiguous extra-lymphatic extension from a nodal site with or without involvement of other lymph node regions on the same side of the diaphragm (IIE).
• Stage III
  • Nodal disease on both sides of diaphragm;
  • may include contiguous extranodal extension (IIIE) and/or spleen (IIIS).
• Stage IV
  Diffuse/disseminated extranodal organ involvement (e.g., liver, marrow, non-contiguous lung, CSF), with or without nodal disease.

Suffixes / modifiers

• A/B: absence/presence of “B symptoms”.
• E: single extranodal site that is contiguous/proximal to nodal disease (or isolated extranodal = IE).
• S: splenic involvement.
• X (bulky): introduced in Cotswolds modification; size definition varies by protocol (7-15 cm or >1/3 thoracic diameter).