What are the limitations of the lugano classification?

While the lugano classification is highly validated, it should not replace clinical judgment. OpiCalc provides the latest evidence-based limitations for the lugano classification to ensure safe bedside use and optimal diagnostic accuracy.

How does the lugano classification compare to other Hematology scores?

The lugano classification is a gold-standard diagnostic tool. OpiCalc provides side-by-side clinical guidance to help clinicians choose the most specific evidence-based tool for their patient's presentation.

Is the lugano classification free to use?

Yes. OpiCalc provides the lugano classification completely ad-free and optimized for mobile bedside use, ensuring you can calculate medical risk swiftly and without distraction.

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IPSID / Lugano Classification

Lugano Staging: An anatomical classification. Stage refers to the involvement of lymph node regions relative to the diaphragm.

Nodal Involvement (Clinical/PET)

Extra-nodal & Modifiers

Clinical Stage (Lugano Classification)

-A

Select nodes to determine stage.

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Staging of Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL) using PET-CT or CT imaging.

Initial diagnostic workup to determine anatomical extent of disease.

Post-treatment assessment (end-of-treatment) to define remission.

Patient Population

Adult and pediatric patients with newly diagnosed or relapsed lymphoma.

Section 2

Formula & Logic

Anatomical Stages

Stage	Involvement
I	Single node region or extralymphatic site (IE)
II	Two or more node regions on the same side of the diaphragm
II Bulky	Stage II with "Bulky" disease (variously defined as > 7–10 cm)
III	Node regions on both sides of the diaphragm; includes spleen (IIIS)
IV	Diffuse or disseminated involvement of one or more extralymphatic organs (e.g., BM, liver, lung)

A / B Designation

Historically, "B" indicates constitutional symptoms (Fever, Night Sweats, Weight Loss), while "A" indicates their absence. In the Lugano 2014 updates, A/B persists mainly for Hodgkin Lymphoma; for NHL, clinical symptoms are documented but no longer change the stage I-IV for trial purposes.

Section 3

Pearls/Pitfalls

PET-CT is Standard

Lugano guidelines recommend PET-CT as the standard for FDG-avid lymphomas (HL, DLBCL, FL). For these lymphomas, a bone marrow biopsy is NOT required if PET-CT clearly shows marrow involvement.

Splenic Stage III

Involvement of the spleen is considered nodal involvement for the purposes of staging; thus, splenic disease below the diaphragm in a patient with cervical nodes above the diaphragm is Stage III.

Section 4

Evidence Appraisal

Primary Consensus

Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification.

Cheson BD et al. • Journal of Clinical Oncology. 2014;32(27):3059-68.

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Section 5

Literature

Evolution

The Lugano classification is the mid-2010s update to the classic Ann Arbor (1971) and Cotswolds (1989) systems, primarily integrating the role of PET imaging and simplifying bone marrow evaluation.

Last Comprehensive Review: 2026

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