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The Lugano classification and response criteria, explained | CION Cancer Clinics
The Lugano criteria are how doctors stage lymphoma from I to IV and judge response on PET-CT. Response uses the five-point Deauville score: a score of 1, 2 or 3 at the end of treatment usually counts as a complete metabolic response, meaning no active lymphoma is seen. This page explains each stage, each score and each report term, and what none of them can tell you. At CION Cancer Clinics, our haematology team plans myeloma and lymphoma care with you, discussed at a tumour board and explained in plain words.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What are the Lugano criteria in lymphoma?
- What do stages I to IV mean under Lugano?
- What does each Deauville score mean?
- Which response words might appear, and what do they mean?
- When is response checked during treatment?
- What do families often misread on response reports?
- What can the Lugano stage and score not tell you?
- Common questions about Lugano staging and response
The short answer
What are the Lugano criteria in lymphoma?
The Lugano criteria are the shared rulebook doctors use to stage lymphoma and to judge how well treatment has worked. Stage runs from I to IV, and response is scored on PET-CT using a five-point scale called the Deauville score. A score of 1, 2 or 3 at the end of treatment usually counts as a complete metabolic response.
Why a shared rulebook matters
Before these rules, different centres described stage and response in slightly different ways. That made it hard to compare reports, move care between hospitals or join clinical trials. Using one system means a report written in Hyderabad can be read the same way anywhere else.
Where you will see it
You will meet the Lugano stage in the letter after your staging scans. You will meet the response words, and often a Deauville score, on a PET-CT report taken partway through or at the end of treatment. The same terms are used for Hodgkin and most non-Hodgkin lymphomas, with small differences your haematologist will point out.
Some lymphomas that take up little sugar are judged on CT size instead of PET brightness. Ask which applies to your type.Staging
What do stages I to IV mean under Lugano?
The diaphragm, the muscle below the lungs, is the dividing line. Stages I and II are often called limited; III and IV advanced.
Stage I
Lymphoma in one lymph node area, or one group of nodes close together. It can also mean a single area outside the nodes with no node involvement.
Stage II
Two or more lymph node areas, all on the same side of the diaphragm. Stage II with a very large mass may be treated like advanced disease.
The letter E after the stage means limited spread into a nearby organ.Stage III
Lymph node areas on both sides of the diaphragm, or nodes above the diaphragm together with the spleen.
Stage IV
Spread into organs beyond the nodes, such as the liver, lungs or bone marrow, in a way that is not simply an extension from a nearby node.
Worth knowing
- Stage IV lymphoma is often treatable
- Stage alone does not set the outlook
Not sure whether this applies to you?
Ask an oncologistOn your PET-CT report
What does each Deauville score mean?
- Score 1
- No sugar uptake above the background at the sites that had lymphoma.
- Score 2
- Uptake no brighter than the mediastinum, the central area of the chest used as a reference.
- Score 3
- Brighter than the mediastinum but no brighter than the liver. Usually read as a good response.
- Score 4
- Moderately brighter than the liver. Whether this is a concern depends on whether it has fallen since the first scan.
- Score 5
- Much brighter than the liver, or new areas of uptake. It needs careful review, sometimes with a biopsy.
Response categories
Which response words might appear, and what do they mean?
Term on the report
What it means in plain words
Complete metabolic response
No active lymphoma seen; Deauville 1, 2 or 3
Partial metabolic response
Still some activity, but clearly less than before
No metabolic response
Activity has not changed meaningfully
Progressive metabolic disease
Activity has increased, or new areas have appeared
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The pathway
When is response checked during treatment?
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Staging, before treatment
A PET-CT sets the starting stage and the baseline brightness. Every later scan is compared with this one, so keep a copy of the images and the report.
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Interim scan, partway through
In some lymphomas, especially Hodgkin, a scan after the first few cycles helps decide whether treatment can be lightened or needs to be strengthened. Not every plan includes one.
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End-of-treatment scan
Usually done some weeks after the last treatment, so inflammation from treatment has time to settle. This scan gives the main Lugano response.
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Follow-up
After a complete response, regular clinic visits and blood tests usually replace routine scans. A scan is repeated if symptoms return or something new is found on examination.
Commonly believed
What do families often misread on response reports?
"Stage IV means it is too late."
Lymphoma behaves differently from many solid cancers. Stage IV lymphoma is often treated with the aim of clearing it, and the type of lymphoma usually matters more than the stage number.
"A Deauville score of 3 means lymphoma is still there."
At the end of treatment, a score of 3 is usually counted as a complete metabolic response. In some trial settings it is read more strictly, and your haematologist will say which applies.
"A leftover lump on CT means treatment failed."
A mass can shrink slowly and leave scar tissue behind. If it is no longer active on PET-CT, it is often just a scar.
"Complete response means we never need to come back."
It means no active lymphoma is seen now. Follow-up visits still matter, because they catch late effects and any return early.
Being straight with you
What can the Lugano stage and score not tell you?
A stage and a Deauville score describe what the scan shows. They do not tell you how long you will live, and they do not decide your treatment on their own. Your haematologist combines them with the lymphoma type, blood tests such as LDH, your age and your general health.
Symptoms still count
For Hodgkin lymphoma, the stage carries a letter A or B. B means you had fevers above 38 degrees Celsius, drenching night sweats, or lost more than a tenth of your body weight within six months without trying. B symptoms can change the treatment plan, so tell the team about them even if they feel minor.
Scores near the line need judgement
A score of 4 can mean very different things depending on how bright the area was at the start. Inflammation, infection and recent growth-factor injections can all brighten a scan. That is why reports near the line are discussed, and sometimes a biopsy is advised before any change of plan. At CION, such reports are reviewed at a tumour board.
Questions we are asked
Common questions about Lugano staging and response
My report says complete metabolic response. Is the lymphoma gone?
It means the scan shows no active lymphoma, which is the result everyone hopes for. It is excellent news, but it is not a promise that the lymphoma will never return. That is why follow-up visits continue. Your haematologist will explain what the plan is from here.
Is Lugano staging the same as Ann Arbor staging?
Lugano is built on the older Ann Arbor system and uses the same stages I to IV. It updated the rules, added PET-CT and the Deauville score, and dropped the A and B symptom letters for most non-Hodgkin lymphomas. Older reports may still use Ann Arbor wording.
What happens if the interim scan shows a score of 4 or 5?
It depends on the lymphoma and the treatment plan. In some cases treatment is strengthened. In others the team first checks whether the brightness is inflammation, sometimes with a biopsy. Do not assume the worst from the number alone. Ask what the plan was designed to do with each result.
Why is the end-of-treatment scan delayed after the last cycle?
Treatment itself causes inflammation, and inflamed tissue can light up on PET-CT. Waiting gives it time to settle, so the scan shows the lymphoma rather than the healing. Radiotherapy usually needs a longer gap than chemotherapy. Your team sets the timing.
Does a higher stage always mean stronger treatment?
Often, but not always. Stage is one input. The type of lymphoma, blood test results, bulky masses and your fitness all shape the plan. Two people with the same stage can be offered different treatment for good reasons.
Can the stage change after treatment starts?
The stage at diagnosis stays as the record of where the lymphoma started. If it comes back later, it is staged again, and your report may add a letter r for relapse. Response scores then track how each round of treatment is working.
Do all lymphomas use the Deauville score?
No. It is used for lymphomas that take up sugar well on PET-CT, such as Hodgkin and diffuse large B-cell lymphoma. Some slow-growing types are judged on CT measurements, blood counts or a marrow test instead. Your haematologist will say which method suits your type.
Can we get the scan reviewed a second time?
Yes. Ask the scan centre for the images on a disc or link as well as the report. Another nuclear medicine doctor can re-read them, which is useful when a score sits near the line and the decision matters. Bring the staging scan too, because comparison is the whole point.
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Sources
- National Cancer Institute — Adult Hodgkin Lymphoma Treatment (PDQ)
- National Cancer Institute — Adult Non-Hodgkin Lymphoma Treatment (PDQ)
- American Cancer Society — Hodgkin Lymphoma
- Cancer.Net — Lymphoma - Non-Hodgkin
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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