Lymphoma — Ann Arbor / Lugano

Ann Arbor stage with the Lugano 2014 modifications (Hodgkin and non-Hodgkin lymphoma)

Ann Arbor stage

I — one lymph node region, or one extralymphatic organ/site

II — two or more lymph node regions on the same side of the diaphragm

III — lymph node regions on both sides of the diaphragm

IV — diffuse or disseminated involvement of one or more extralymphatic organs (± nodes)

Extranodal involvement

None — nodal disease only

Localised, contiguous extralymphatic extension from a nodal site (E)

Diffuse or non-contiguous extralymphatic organ involvement

B symptoms (unexplained fever, drenching night sweats, or > 10% weight loss over 6 months)

Bulky disease (single mass ≥ 10 cm, or > 1/3 of the thoracic diameter)

Evidence

Original publication

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. Retained the Ann Arbor stages I–IV with A/B and E designators, removed routine use of the X (bulk) suffix for staging while keeping bulk as a prognostic factor, and defined limited (I–II non-bulky) versus advanced disease for treatment.

Journal of Clinical Oncology, 2014

Open source

Guideline

PET-CT is the standard imaging for FDG-avid lymphomas. The Ann Arbor stage is combined with prognostic indices (IPI, IPS, FLIPI) and, for Hodgkin lymphoma, bulk, to choose treatment. Confirm against the Lugano publication.

Last reviewed: 2026-09

Report an error in this calculator

MedScore is an educational and clinical decision-support tool. It does not provide a diagnosis, a treatment, or a drug-dosing recommendation, and it does not replace clinical judgement or local guidelines. Confirm every result against the original source before acting on it. The treating clinician remains responsible for all decisions.