Hodgkin’s Lymphoma Staging: Ann Arbor Staging System


Ann Arbor system is most commonly used the system for staging. It helps to determine the disease prognosis and to select an appropriate treatment strategy.

It assigns four stages (I, II, III, and IV) to the Hodgkin’s Lymphoma. Letter ‘E’ can be added, which indicate that HL affects an organ outside of the lymphatic system (extranodal site).

Each stage can also be subdivided into A and B categories. “A” indicates absence of A symptoms and “B” indicates presence of B-symptoms(unexplained weight loss, fever, and night sweats).

Sometimes, letter X is added to Stage I or II, which indicate bulky disease. A bulky disease can be assessed with the help of mediastinal mass ratio (MMR, a ratio of the maximum width of the tumor mass and the maximum intrathoracic diameter) as a tumor mass of >0.33 MMR.

Alternatively, a bulky disease is defined as a single node or nodal mass that is 10 cm or greater in diameter.

Following table describe the characteristics of HL according to different Lugano stages:

IHL is limited to only one site in the lymphatic system (single lymph node or lymphoid organ) OR only one site outside the lymphatic system is involved (IE).
IIHL has extended to 2 or more lymph nodes regions on the same side of the diaphragm OR involvement of an extralymphatic site adjacent to the involved nodal site (IIE).
IIIHL has spread to lymph nodes regions on both sides of the diaphragm OR HL has affected lymph nodes above the diaphragm and the spleen (IIIS).
IVInvolvement of liver and/or bone OR involvement of a nodal site with non-regional extranodal site involvement.

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