Stage is important in selecting a treatment for patients with non-Hodgkin’s
lymphoma (NHL). Chest and abdominal computed tomographic (CT) scans are
usually part of the staging evaluation for all lymphoma patients. The staging
system is similar to the staging system used for Hodgkin’s lymphoma.
Noncontiguous lymph node involvement, uncommon in Hodgkin’s lymphoma, is more
common among patients with NHL. Involvement of Waldeyer’s ring, epitrochlear
nodes, and the gastrointestinal tract is also more common. Extranodal
presentations are more common in NHL. A single extranodal site is occasionally
the only site of involvement in patients with diffuse lymphoma. Bone marrow
and hepatic involvement are especially common in patients with low-grade
lymphomas. Cytologic examination of cerebrospinal fluid may be positive in
patients with aggressive NHL. Involvement of hilar and mediastinal lymph nodes
is less common than in Hodgkin’s lymphoma. Mediastinal adenopathy, however, is a
prominent feature of lymphoblastic lymphoma and primary mediastinal B-cell
lymphoma, entities primarily found in young adults.
The majority of patients with NHL present with advanced (stage III or stage IV)
disease that can often be identified with limited staging procedures such as CT
scanning and biopsies of the bone marrow and other accessible sites of
involvement. Laparoscopic biopsy or laparotomy is not required for staging but
may be necessary to establish a diagnosis or histologic type. Positron
emission tomography with fluorine-18-fluorodeoxyglucose can be used for
initial staging and for follow-up after therapy as a supplement to CT
Staging Subclassification System
The Ann Arbor staging system is commonly used for patients with NHL.[6,7] In
this system, stage I, stage II, stage III, and stage IV adult NHL can be subclassified into A
and B categories: B for those with well-defined generalized symptoms and A for
those without such symptoms. The B designation is given to patients with any of the
- Unexplained loss of more than 10% of body weight in the 6 months before
- Unexplained fever with temperatures above 38° C.
- Drenching night sweats.
Occasionally, specialized staging systems are used. The physician should be
aware of the system used in a specific report.
Stage I NHL means involvement of a single lymph node region (I) or localized
involvement of a single extralymphatic organ or site (IE).
Stage II NHL means involvement of two or more lymph node regions on the same side
of the diaphragm (II) or localized involvement of a single associated
extralymphatic organ or site and its regional lymph nodes with or without other
lymph node regions on the same side of the diaphragm (IIE). The number
of lymph node regions involved may be indicated by a subscript (e.g., II3).