Ann Arbor staging system

Last revised by Daniel J Bell on 19 Nov 2021

The Ann Arbor staging system was the landmark lymphoma staging classification system for both Hodgkin lymphoma and non-Hodgkin lymphoma. It is named after the town of Ann Arbor in the US state of Michigan where the Committee on Hodgkin's Disease Staging Classification met in 1971 to agree on it. It updated and replaced the earlier Rye staging system 2

This classification has since been updated and modified, with the currently used criteria being the Lugano classification and the LYRIC classification.

Staging system

  • stage I: involvement of a single lymph node region or of a single extralymphatic organ or site
  • stage II: involvement of two or more lymph node regions on the same side of the diaphragm or localized involvement of an extralymphatic organ or site 
  • stage III: involvement of lymph node regions or structures on both sides of the diaphragm
  • stage IV: diffuse or disseminated involvement of one or more extralymphatic organs, or either: 
    • isolated extralymphatic organ involvement without adjacent regional lymph node involvement, but with disease in distant sites
    • involvement of the liver, bone marrow, pleura or cerebrospinal fluid

Additional substaging variables include:

  • A: asymptomatic
  • B: presence of B symptoms (including fever, night sweats and weight loss of ≥10% of body weight over 6 months)
  • E: involvement of a single, extranodal site, contiguous or proximal to a known nodal site (stages I to III only; additional extranodal involvement is stage IV)
  • S: splenic involvement
  • X: bulky nodal disease: nodal mass >1/3 of intrathoracic diameter or 10 cm in dimension

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Cases and figures

  • Figure 1: lymph node regions
    Drag here to reorder.
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