Diffuse large B cell lymphoma diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2] Anila Hussain, MD [3]


According to the Lugano classification, there are four stages of diffuse large B cell lymphoma based on the number of nodes involved and extranodal status. Recommendations for staging and restaging of lymphoma that are developed by the clinical and imaging working groups of the international conference of malignant lymphomas (Lugano classification), fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) scan is now recommended as the gold standard for staging DLBCL patients.


Staging for diffuse large B-cell lymphoma is provided in the following table:[1]

Revised staging system for primary nodal lymphomas (Lugano classification)
Stage Involvement Extranodal (E) status
I One node or a group of adjacent nodes Single extranodal lesions without nodal involvement
II Two or more nodal groups on the same side of the diaphragm Stage I or II by nodal extent with limited contiguous extranodal involvement
II bulky* II as above with "bulky" disease Not applicable
III Nodes on both sides of the diaphragm; nodes above the diaphragm with spleen involvement Not applicable
IV Additional noncontiguous extralymphatic involvement Not applicable
Ann Arbor Staging Classification
I Involvement of a single Lymphatic Region (I)


Localized involvement of single Extra lymphatic organ or site (IE)

II Involvement of 2 or more lymphatic regions on the same side of diaphragm (II)


Localized involvement of a single extralymphatic organ or site and of one or more lymphatic Regions on the same side of the Diaphragm (IIE)

III Involvement of lymphatic regions on both sides of the diaphragm
IV Diffuse or disseminated involvement of one or more extralymphatic organs with or without lymphatic involvement


  1. Cheson, Bruce D.; Fisher, Richard I.; Barrington, Sally F.; Cavalli, Franco; Schwartz, Lawrence H.; Zucca, Emanuele; Lister, T. Andrew; Alliance, Australasian Leukaemia and Lymphoma Group; Eastern Cooperative Oncology Group; European Mantle Cell Lymphoma Consortium; Italian Lymphoma Foundation; European Organisation for Research; Treatment of Cancer/Dutch Hemato-Oncology Group; Grupo Español de Médula Ósea; German High-Grade Lymphoma Study Group; German Hodgkin's Study Group; Japanese Lymphorra Study Group; Lymphoma Study Association; NCIC Clinical Trials Group; Nordic Lymphoma Study Group; Southwest Oncology Group; United Kingdom National Cancer Research Institute (2014-09-20). "Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification". Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. 32 (27): 3059–3068. doi:10.1200/JCO.2013.54.8800. ISSN 1527-7755. PMID 25113753.

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