What is the Cotswolds modification of Ann Arbor staging system for follicular lymphoma (non-Hodgkin lymphoma)?

Updated: Feb 11, 2020
  • Author: Francisco J Hernandez-Ilizaliturri, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
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Answer

Answer

The Cotswolds modification maintains the original 4-stage clinical and pathologic staging framework of the Ann Arbor staging system but also adds information regarding the prognostic significance of bulky disease (denoted by an X designation) and regions of lymph node involvement (denoted by an E designation). [4]

The A and B designations denote the absence or presence of symptoms, respectively; the presence of symptoms correlates with treatment response. The importance of imaging modalities, such as computed tomography (CT) scanning, is also underscored. [4]

Table. Cotswolds modification of Ann Arbor staging system (Open Table in a new window)

Stage

Area of involvement

I

Single lymph node group

II

Multiple lymph node groups on same side of diaphragm

III

Multiple lymph node groups on both sides of diaphragm

IV

Multiple extranodal sites or lymph nodes and extranodal disease

X

Bulk > 10 cm

E

Extranodal extension or single isolated site of extranodal disease

A/B

B symptoms: weight loss > 10%, fever, drenching night sweats


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