Lugano classification (lesion measurement guidelines)

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The Lugano classification is a lymphoma staging system resulting from recommended changes in 2011 to the Cotswolds modified Ann Arbor staging. This article outlines the lesion measurement guidelines for the system:

Eligible lesions
  • lymph nodes: the longest diameter in axial plane should be >1.5 cm
  • extranodal lesions: the longest diameter in the axial plane should be >1.0 cm
Selection of lesions

Lesions chosen should be measurable in two dimensions.

CT (or 18F-FDG PET-CT): tumor burden is to be calculated at baseline staging:

  • choose up to six of the largest nodes, nodal complexes or other lymphoma deposits
  • measure the longest diameter and shortest diameter of each lesion in the axial plane
  • multiply the longest diameter and shortest diameter for each lesion to give the “product of the diameters”
  • add these to give the “sum of the product of the diameters” (SPD) - the SPD calculated at the time of staging will serve as the baseline for sequential quantification of tumor burden at interim and end-of-therapy FDG PET-CT

Spleen measurement includes the largest transverse diameter and the perpendicular diameter in the axial plane, besides the craniocaudal diameter in the coronal plane. Splenomegaly is defined as vertical splenic length >13.0 cm.