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).
FDG-PET/CT for staging and treatment response in both clinical routine and clinical trials using the Deauville 5ps is recommended in 2:
- 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 2:
- primary extranodal and
- cutaneous lymphomas, e.g. cutaneous T-cell lymphoma (CTCL), cutaneous B-cell lymphomas (CBCL)
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 6
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 7
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 4,5.
- 1. Barrington SF, Mikhaeel NG, Kostakoglu L et-al. Role of Imaging in the Staging and Response Assessment of Lymphoma: Consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J. Clin. Oncol. 2014;32 (27): . doi:10.1200/JCO.2013.53.5229 - Pubmed citation
- 2. Cheson BD, Fisher RI, Barrington SF et-al. Recommendations for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The Lugano Classification. J. Clin. Oncol. 2014;32 (27): . doi:10.1200/JCO.2013.54.8800 - Pubmed citation
- 3. Gallamini A, Barrington SF, Biggi A et-al. The predictive role of interim positron emission tomography for Hodgkin lymphoma treatment outcome is confirmed using the interpretation criteria of the Deauville five-point scale. Haematologica. 2014;99 (6): 1107-13. doi:10.3324/haematol.2013.103218 - Free text at pubmed - Pubmed citation
- 4. Biggi A, Gallamini A, Chauvie S et-al. International validation study for interim PET in ABVD-treated, advanced-stage hodgkin lymphoma: interpretation criteria and concordance rate among reviewers. J. Nucl. Med. 2013;54 (5): 683-90. doi:10.2967/jnumed.112.110890 - Pubmed citation
- 5. Barrington SF, Qian W, Somer EJ et-al. Concordance between four European centres of PET reporting criteria designed for use in multicentre trials in Hodgkin lymphoma. Eur. J. Nucl. Med. Mol. Imaging. 2010;37 (10): 1824-33. doi:10.1007/s00259-010-1490-5 - Pubmed citation
- 6. Moskowitz CH. Interim PET-CT in the management of diffuse large B-cell lymphoma. Hematology Am Soc Hematol Educ Program. 2013;2012: 397-401. Pubmed citation
- 7. Dabaja BS, Phan J, Mawlawi O, Medeiros LJ, Etzel C, Liang FW, Podoloff D, Oki Y, Hagemeister FB, Chuang H, Fayad LE, Westin JR, Shihadeh F, Allen PK, Wogan CF, Rodriguez MA. Clinical implications of positron emission tomography-negative residual computed tomography masses after chemotherapy for diffuse large B-cell lymphoma. (2013) Leukemia & lymphoma. 54 (12): 2631-8. doi:10.3109/10428194.2013.784967 - Pubmed