deauville five-point scale

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The Deauville five-point scale (Deauville 5PS) is an internationally-recommended scale for routine clinical reporting and clinical trials using FDG PET-CT in the initial staging and assessment of treatment response in Hodgkin lymphoma (HL) and certain types of non-Hodgkin lymphomas (NHL).

Inclusions

FDG-PET/CT for staging and treatment response in both clinical routine and clinical trials using the Deauville 5ps is recommended in :

Hodgkin lymphoma (HL), any type
diffuse large B cellular lymphoma (DLBCL)
marginal zone NHL with an aggressive transformation
FDG-avid nodal lymphomas, essentially all histologic types except:

whereas there have been proposed separate criteria for :

primary extranodal and
cutaneous lymphomas, e.g. cutaneous T-cell lymphoma (CTCL), cutaneous B-cell lymphomas (CBCL)

Usage

It is a simple tool based on visual interpretation of FDG uptake. It takes advantage of two reference points of the individual patient, which have demonstrated relatively constant uptake on serial imaging. The two reference organs are the mediastinum (a.k.a. blood pool) and the liver.

The scale ranges from 1 to 5, where 1 is best and 5 is the worst. Each FDG-avid (or previously FDG-avid) lesion is rated independently:

no uptake or no residual uptake (when used interim)

slight uptake, but equal to or below blood pool (mediastinum)

uptake above mediastinal, but below or equal to uptake in the liver

uptake slightly to moderately higher than liver

markedly increased uptake or any new lesion (on response evaluation)

Some authors also use:

X for any lesion not overtly attributable to lymphoma

Assessment of treatment response

complete response (CR): scores 1, 2 or 3 together with the absence of FDG-avid bone marrow lesion(s) are interpreted as complete metabolic response (CR), irrespective of a persistent mass on CT
partial response (PR): a Deauville score of 4 or 5, provided:
- uptake is decreased compared with baseline and
- absence of structural progression development on CT
stable disease (SD), also called no metabolic response: a Deauville score of 4 or 5 without significant change in FDG uptake from baseline.
progressive disease (PD): a Deauville score of 4 to 5 with increasing intensity compared to baseline or any interim scan and/or any new FDG-avid focus consistent with malignant lymphoma

Caveat

It is often stated that DLBCL patients who demonstrate a complete metabolic response (Deauville 1) but have a residual mass of greater than 2 cm are at an increased risk of recurrence.

History and etymology

The scale was proposed in an international workshop attended by hematologists and nuclear medicine specialists in Deauville, France in 2009 .