Cotswolds-modified Ann Arbor classification

Last revised by Daniel J Bell on 19 Nov 2021

The Cotswolds-modified Ann Arbor classification is a lymphoma staging classification system for both Hodgkin lymphoma and non-Hodgkin lymphoma. They came about in 1988 following recommended modifications to the Ann Arbor staging system after a meeting in Cotswold, England.

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: one nodal group or lymphoid organ (e.g. spleen or thymus)
    • stage IE: one extranodal site
  • stage II: two or more nodal groups, same side of the diaphragm
    • stage IIE: localized extranodal site with stage II criteria, both on the same side of the diaphragm
  • stage III: nodal groups on both sides of the diaphragm
    • stage IIIS(1): with splenic involvement
    • stage IIIE(2): with localized extranodal site
    • stage IIISE: both
  • stage IV: disseminated involvement of one or more extralymphatic organ (e.g. lung, bone) with or without any nodal involvement

Additional sub-staging variables:

  • A: asymptomatic
  • B: presence of B symptoms (including fever, night sweats and weight loss of over 10% of body weight over 6 months)
  • 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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