Lugano staging (2014)

Modern Lymphoma staging that keeps Ann Arbor anatomic stages but formally integrates FDG PET-CT for FDG-avid lymphomas and standardises terminology.

Key updates

• PET-CT is incorporated into standard staging for FDG-avid lymphomas; CT is used for non-/variably FDG-avid histologies.
• Ann Arbor-style anatomic description still used, but A/B suffix is kept only for HL.
• “X bulky” is not necessary in Lugano; instead report the largest tumour diameter (and describe mass effect/complications).
• Bone marrow biopsy: if PET-CT is done, it’s not routinely indicated for HL, and often can be avoided in most DLBCL.

Practical grouping

Many protocols simplify to

• limited (I–II non-bulky)
• Advanced (III–IV)
• Stage II bulky may be handled variably depending on histology/prognostic factors.

“E” suffix nuances

• Lugano still uses E suffix for limited extra-nodal disease e.g. IE and IIE.
• E does not apply to stage III nodal disease as it is not relevant to patients with advanced-stage disease.