From the Guidelines
The staging for Hodgkin's lymphoma is based on the Ann Arbor staging system, which divides each stage into subcategories A and B, depending on the presence of B symptoms.
Staging System
- The Ann Arbor staging system is used to stage Hodgkin's lymphoma, with stages ranging from I to IV, and subcategories A and B indicating the presence or absence of systemic symptoms such as unexplained fevers, night sweats, or weight loss 1.
- The system classifies patients into three groups: early-stage favorable, early-stage unfavorable, and advanced-stage disease, based on factors such as stage, presence of B symptoms, and bulky disease 1.
Key Factors
- B symptoms are defined as unexplained fevers >38°C, drenching night sweats, or weight loss of >10% of body weight within 6 months of diagnosis 1.
- Bulky disease is defined as a mediastinal mass ratio (MMR) >0.33, or a single node or nodal mass ≥10 cm in diameter, and is considered an unfavorable prognostic factor in early-stage disease 1.
- Staging evaluation may include fluorodeoxyglucose (FDG) positron emission tomography (PET)–computed tomography (CT), but bone marrow biopsy is no longer routine for Hodgkin's lymphoma staging 1.
From the Research
Staging of Hodgkin's Lymphoma
The staging of Hodgkin's lymphoma is a critical process that determines the extent of the disease and guides treatment decisions. According to 2, the Ann Arbor classification is still used for disease localization, but patients are now treated as having limited disease (I, II) or extensive disease (III-IV), directed by prognostic and risk factors.
Factors Influencing Staging
Several factors influence the staging of Hodgkin's lymphoma, including:
- The histology of the disease
- The anatomical stage
- The presence of poor prognostic features
- The response to therapy as determined by positron emission tomography (PET) scan 3, 4
Role of Imaging Modalities
Imaging modalities, such as PET/CT, play a crucial role in the staging and response assessment of Hodgkin's lymphoma. According to 5, PET/CT is now an integral part of the workup and management of patients with Hodgkin's lymphoma, and is used for staging, response assessment, and prognostication. Whole-body positron emission tomography (PET) scanning with fluorodeoxyglucose (FDG) is also a promising new tool for evaluating residual masses and assessing early response to chemotherapy 6.
Staging Classification
The Lugano classification, updated in 2011, recommends the use of PET-CT for staging FDG-avid lymphomas, and CT for non-avid lymphomas 2. The classification also suggests that patients be treated as having limited or extensive disease, rather than being staged according to the traditional Ann Arbor classification.
Treatment Implications
The staging of Hodgkin's lymphoma has significant implications for treatment. Patients with early-stage disease are typically treated with combined modality strategies, while those with advanced-stage disease receive a longer course of chemotherapy often without radiation therapy 3, 4. Accurate staging is critical to ensure that patients receive the most effective treatment for their disease.