Lugano classification (response to treatment on CT)

Last revised by Daniel J Bell on 2 Sep 2022

The Lugano classification is a lymphoma staging system resulting from recommended changes in 2011 to the Ann Arbor staging with Cotswolds modifications. This article outlines the classification's response to treatment based on CT

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

Non-progressive disease
  • complete response
    • nodal site reduce ≤1.5 cm in longest transverse diameter (LDI) of a lesion
    • complete disappearance of radiologic evidence of disease
  • partial response
    • ≥50% decrease in sum of the product of the perpendicular diameters (PPDs) of up to six representative nodes or extranodal lesions
  • stable disease
    • <50% decrease from baseline in PPDs of up to six dominant, measurable nodes and extranodal sites
    • no criteria for progressive disease are met
​​Progressive disease
  1. new or increased adenopathy; an individual node must be abnormal with:
    • (a) longest transverse diameter (LDi) >1.5 cm AND
    • (b) PPD increase by ≥50% from nadir AND
    • (c) longest transverse diameter (LDi) or shortest axis perpendicular to LDi (SDi) increase from nadir; the increase in LDi or SDi from nadir (the smallest recorded measurement) must be >0.5 cm for lesions ≤2 cm and >1.0 cm for lesions >2 cm
  2. splenic volume increase:
    • (a) with prior splenomegaly: increase in length by >50% of its prior increase beyond baseline; for example, splenic length increases from 15 cm (2 cm above baseline splenomegaly of 13 cm) to >16 cm (>3 cm above baseline)
    • (b) without prior splenomegaly: length increase by at least 2 cm
    • (c) new or recurrent splenomegaly
  3. new or larger non-measured lesions
  4. recurrent previously resolved lesions
  5. new extranodal lesion >1 cm in any axis (new lesions <1 cm in any axis are included if these are “unequivocally attributable” to lymphoma)
  6. a new node >1.5 cm in any axis ​

History and etymology

In June 2011, the 11th International Conference on Malignant Lymphoma took place in Lugano, Switzerland. At this gathering leading medical specialists from major cancer centers and academic groups discussed the way in which Hodgkin and non-Hodgkin lymphoma were evaluated and staged, and how treatment response was assessed. At the 12th International Conference on Malignant Lymphoma, their conclusions were adopted to form the Lugano classification 1.

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Cases and figures

  • Table 1: Lugano classification: response evaluation criteria (table)
    Drag here to reorder.
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