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Revised staging system for primary nodal lymphomas (Lugano classification)

Stage	Involvement	Extranodal (E) status
Limited
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
Advanced
III	Nodes on both sides of the diaphragm; nodes above the diaphragm with spleen involvement	Not applicable
IV	Additional noncontiguous extralymphatic involvement	Not applicable

Extent of disease is determined by positron emission tomograph/computed tomography (PET/CT) for avid lymphomas and CT for nonavid histologies. Tonsils, Waldeyer's ring, and spleen are considered nodal tissue.

* Whether stage II bulky disease is treated as limited or advanced disease may be determined by histology and a number of prognostic factors.

From: Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: The Lugano classification. J Clin Oncol 2014; 32(27):3059-67. Reprinted with permission. Copyright © 2014 American Society of Clinical Oncology. All rights reserved.

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