Lugano classification (response to treatment on CT)

The Lugano classification is a lymphoma staging system resulting from recommended changes in 2011 to the Ann Arbor staging with Cotswolds modifications. This article outlines the classification's response to treatment based on CT

Also included in the classification are staging and reponse to treatment based on PET/CT.

Non-progressive disease
  • complete response
    • nodal site reduce ≤1.5 cm in longest transverse diameter (LDI) of a lesion
    • complete disappearance of radiologic evidence of disease
  • partial response
    • for single lesions
      • if only a single lesion is present, ≥ 50% decrease in sum of the product of the perpendicular diameters (SPD) of up to six target measurable nodes and extranodal sites
    • for multiple lesions
      • ≥50% decrease in sum of the product of the perpendicular diameters (PPD)
  • stable disease
    • <50% decrease from baseline in SPD of up to six dominant, measurable nodes and extranodal sites
    • no criteria for progressive disease are met
​​Progressive disease
  1. new or increased adenopathy; an individual node must be abnormal with:
  2. (a) longest transverse diameter (LDi) >1.5 cm AND
  3. (b) PPD increase by ≥50% from nadir AND
  4. (c) longest transverse diameter (LDi) or shortest axis perpendicular to LDi (SDi) increase from nadir; the increase in LDi or SDi from nadir (the smallest recorded measurement) must be >0.5 cm for lesions ≤2 cm and >1.0 cm for lesions >2 cm
  5. splenic volume increase:
  6. (a) with prior splenomegaly: increase in length by >50% of its prior increase beyond baseline; for example, splenic length increases from 15 cm (2 cm above baseline splenomegaly of 13 cm) to >16 cm (>3 cm above baseline)
  7. (b) without prior splenomegaly: length increase by at least 2 cm
  8. (c) new or recurrent splenomegaly
  9. new or larger nonmeasured lesions
  10. recurrent previously resolved lesions
  11. new extranodal lesion >1 cm in any axis (new lesions <1 cm in any axis are included if these are “unequivocally attributable” to lymphoma)
  12. a new node >1.5 cm in any axis ​


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Cases and figures

  • Table 1: Lugano classification: response evaluation criteria (table)
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