Lugano classification (PET-CT treatment response)

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The Lugano classification is a lymphoma staging system for non-Hodgkin and Hodgkin lymphoma. This article outlines the classification's response to treatment based on PET-CT.

Also included in the classification are staging and response to treatment based on CT.

Scoring system

The Lugano classification recommends the Deauville five-point scale for reporting response by FDG PET-CT:

  • no uptake or no residual uptake (when used interim) 
  • slight uptake, but 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)
    • Non-progressive disease
    • complete metabolic response (CMR)
      • score of 1, 2 or 3 in nodal or extranodal sites with or without a residual mass
    • partial metabolic response (PMR)
      • score of 4 or 5 with reduced uptake compared with baseline and residual mass(es) of any size
    • stable disease or no metabolic response
      • score of 4 or 5 with no obvious change in FDG uptake
    Progressive disease
    • score 4 or 5 in any lesion with an increase in intensity of FDG uptake from baseline (and/or new FDG-avid foci consistent with lymphoma)