Lugano classification (PET-CT treatment response)

Last revised by Daniel J Bell on 3 Feb 2020

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:

  1. no uptake or no residual uptake (when used interim) 
  2. slight uptake, but below blood pool (mediastinum) 
  3. uptake above mediastinal, but below or equal to uptake in the liver
  4. uptake slightly to moderately higher than liver
  5. 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)

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