Deauville five-point scale

The Deauville five-point scale (Deauville 5ps(Deauville 5PS)is an internationally-recommended scale for routine clinical reporting and clinical trials using FDG-PET/CT in the initial staging and assessment of treatment response in Hodgkin lymphoma (HL) and certain types of non-Hodgkin lymphomas (NHL). 

Inclusions

FDG-PET/CT for staging and treatment response in both clinical routine and clinical trials using the Deauville 5ps is recommended in ²:

• Hodgkin lymphoma (HL), any type
• diffuse large B cellular lymphoma (DLBCL)
• marginal zone NHL with an aggressive transformation
• FDG-avid nodal lymphomas, essentially all histologic types except:
  • chronic lymphocytic leukemia (CLL)
  • small lymphocytic lymphoma
  • lymphoplasmacytic lymphoma / Waldenström macroglobulinaemia
  • mycosis fungoides

whereas there have been proposed separate criteria for ²:

• primary extranodal and
• cutaneous lymphomas, e.g. cutaneous T-cell lymphoma (CTCL), cutaneous B-cell lymphomas (CBCL)

Usage

It is a simple tool based on visual interpretation of FDG-uptake. It takes advantage of two reference points of the individual patient, which have demonstrated relatively constant uptake on serial imaging. The two reference organs are the mediastinum (aka(a.k.a. blood pool) and the liver. 

The scale ranges from 1 to 5, where 1 is best and 5 is the worst. Each FDG-avid (or previously FDG-avid) lesion is rated independently.:

1. no uptake or no residual uptake (when used interim) 
2. slight uptake, but below blood pool (mediastinum) 
3. uptake above mediastinal, but below or equal to uptake in the liver
4. uptake slightly to moderately higher than liver
5. markedly increased uptake or any new lesion (on response evaluation)

Some authors also use:

• X for any lesion not overtly attributable to lymphoma ⁶ 

Assessment of treatment response

• complete response (CR): scores 1, 2 or 3 together with the absence of FDG-avid bone marrow lesion(s) are interpreted as complete metabolic response (CR), irrespective of a persistent mass on CT
• partial response (PR): a Deauville score of 4 or 5, provided: 
  • uptake is decreased compared with baseline and
  • absence of structural progression development on CT
• stable disease (SD), also called no metabolic response: a Deauville score of 4 or 5 without significant change in FDG uptake from baseline. 
• progressive disease (PD): a Deauville score of 4 to 5 with increasing intensity compared to baseline or any interim scan and/or any new FDG-avid focus consistent with malignant lymphoma ⁷

Caveat

It is often stated that that DLBCL patients who demonstrate a complete metabolic response (Deauville 1) but have a residual mass of greater than 2 cm are at an increased risk of recurrence.

History and etymology

The scale was proposed in an international workshop attended by haematologists and nuclear medicine specialists in Deauville, France in 2009 ^4,5. 

See also

• WHO classification of neoplastic diseases of lymphoid tissues