How does the Lugano classification stage NHL/B-cell lymphoma?

Updated: Feb 23, 2021
  • Author: Mohammad Muhsin Chisti, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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In 2014, the International Conference on Malignant Lymphomas (a multidisciplinary team of researchers representing major lymphoma clinical trial groups and cancer centers from North America, Europe, Japan, and Australasia) met in Lugano, Italy and created a modification of the Ann Arbor system, the Lugano classification. [15] The 2015 NCCN Non-Hodgkin’s Lymphomas guidelines adopted the Lugano classification. [16]

The Lugano classification (see Table 3, below) includes four stages. However, the A and B subclassifications are not required in NHL since they are not prognostic.


Table 3. Lugano Modification of the Ann Arbor Staging System. (Open Table in a new window)


Area of Involvement

Extranodal (E) Status


Single node or adjacent group of nodes

Single extranodal lesions without nodal involvement


Multiple lymph node groups on same side of diaphragm

Stage I or II by nodal extent with limited contiguous extranodal involvement

II bulky*

Multiple lymph node groups on same side of diaphragm with “bulky disease”.



Multiple lymph node groups on both sides of diaphragm; nodes above the diaphragm with spleen involvement



Multiple noncontiguous extranodal sites


*Stage II bulky disease considered limited or advanced as determined by histology and a number of prognostic factors.

Suffixes A and B are not required

X for bulky disease replaced with documenting of largest tumor diameter

Definition of “Bulky” disease varies depending on lymphoma histology.

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