Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more
for patients with Hodgkin's lymphoma (HL) includes a history, physical examination, laboratory studies (including
sedimentation rate), and thoracic and abdominal/pelvic computerized tomographic
(CT) scans. Positron emission tomography (PET) scans, sometimes combined with CT scans, have replaced gallium scans and lymphangiography for clinical staging.[2,3,4] The use of PET scans to assess response and define the use or avoidance of further treatment is under clinical evaluation.[5,6] Bone marrow involvement occurs in 5% of patients; biopsy is indicated
in the presence of constitutional B symptoms or anemia, leukopenia, or
thrombocytopenia. Staging laparotomy is no longer recommended; it
should be considered only when the results will allow substantial reduction in
treatment. It should not be done in patients who require chemotherapy. If the laparotomy is required for treatment decisions, the risks
of potential morbidity should be considered.[7,8,9,10] The staging classification
that is currently used for HL was adopted in 1971 at the Ann
Arbor Conference with some modifications 18 years later from the Cotswolds
SUBCLASSIFICATION OF STAGE
Stages I, II, III, and IV adult HL can be subclassified into A
and B categories: B for those with defined general symptoms and A for those
without B 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.
The most significant B symptoms are fevers and weight loss. Night
sweats alone do not confer an adverse prognosis. Pruritus as a systemic
symptom remains controversial and is not considered a B symptom in the Ann
Arbor staging system. This symptom is hard to define quantitatively and
uniformly, but when it is recurrent, generalized, and otherwise unexplained, and
when it ebbs and flows parallel to disease activity, it may be the equivalent
of a B symptom.
The designation E is used when well-localized extranodal lymphoid malignancies
arise in or extend to tissues beyond, but near, the major lymphatic aggregates.
Stage IV refers to disease that is diffusely spread throughout an extranodal
site, such as the liver. If pathologic proof of involvement of one or more
extralymphatic sites has been documented, the symbol for the site of
involvement, followed by a plus sign (+), is listed.
Sites are identified by the following notations:
|N = nodes||H = liver ||L = lung|| M = bone marrow|
|S = spleen|| P = pleura||O = bone|| D = skin|