Lugano

classification for lymphoma response

Assesses lymphoma staging and treatment response.

vigenteLymphoma imaging consensus2014PET, CT

CMRComplete metabolic response PMRPartial metabolic response SDNo metabolic response PMDProgressive metabolic disease

Aplicar o Lugano a um achado

Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.

Categorias

Reescritas a partir da fonte e citadas

CMR

1 de 4

Complete metabolic response

Complete Metabolic Response: on FDG-PET, a Deauville 5-point score of 1, 2 or 3 (uptake at or below liver) at any residual mass, with no new FDG-avid disease; on CT, target nodes/nodal masses regress to <=1.5 cm in the longest transverse diameter, with no new lesions.

CondutaIndicates treatment success / no metabolically active disease; supports completing or de-escalating planned therapy and proceeding to surveillance per protocol.

RiscoFavourable response with strong prognostic value: in Hodgkin lymphoma a negative predictive value of ~95-100% (positive predictive value >90%) is reported, and ~80-100% NPV in aggressive non-Hodgkin lymphoma.

verificadoRecommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma (Lugano)PMC4979083 (Cheson et al., 'Recommendations for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The Lugano Classification') Table 3 'Revised Criteria for Response Assessment', Complete Response row (PET 5PS score 1, 2 or 3; CT 'target nodes/nodal masses must regress to <=1.5 cm in LDi'); prognostic NPV/PPV figures from the PET response-assessment text

PMR

2 de 4

Partial metabolic response

Partial Metabolic Response: on FDG-PET, a Deauville score of 4 or 5 but with reduced uptake compared with baseline (and, at interim, residual masses of any size); on CT, at least a 50% decrease in the sum of the products of perpendicular diameters (SPD) of up to 6 target measurable nodes/extranodal sites, with no new lesions and no progression.

CondutaAt interim, reduced uptake (5PS 4-5 but lower than baseline) suggests chemo-sensitive disease and supports continuing therapy; at end of treatment, residual metabolically active disease warrants biopsy or a follow-up scan if further treatment is being considered.

RiscoIndicates residual disease; end-of-treatment PMR carries less favourable prognosis than CMR and requires confirmation of activity before changing management.

verificadoRecommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma (Lugano)PMC4979083 Table 3 'Revised Criteria for Response Assessment', Partial Response row (PET 5PS score 4-5 with reduced uptake vs baseline; CT '>=50% decrease in SPD of up to 6 target measurable nodes'); management text on interim chemo-sensitivity and end-of-treatment biopsy/follow-up scan from the PET response-assessment text

3 de 4

No metabolic response

No Metabolic Response / Stable Disease: on FDG-PET, a Deauville score of 4 or 5 with no significant change in uptake from baseline; on CT, a less-than-50% decrease in the SPD of target lesions from baseline, without meeting any criterion for progressive disease.

CondutaLack of meaningful response; prompts reassessment of the treatment strategy, with confirmation of residual disease (biopsy or repeat imaging) before any change as for residual PET-active disease.

RiscoUnfavourable response category — disease neither responding adequately nor formally progressing, conferring a poorer prognosis than metabolic response.

verificadoRecommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma (Lugano)PMC4979083 Table 3 'Revised Criteria for Response Assessment', No Response or Stable Disease row (PET 5PS score 4-5 with no significant change from baseline; CT '<50% decrease from baseline in SPD ... no criteria for progressive disease met')

PMD

4 de 4

Progressive metabolic disease

Progressive Metabolic Disease: on FDG-PET, a Deauville score of 4 or 5 with increased uptake intensity from baseline and/or new FDG-avid foci consistent with lymphoma; on CT, an individual node/lesion that grows (e.g. >=50% increase in SPD from nadir with the required absolute size increase) or the appearance of any new lesion.

CondutaTreatment failure; indicates a change of therapy (next-line/salvage regimen), with biopsy of new or progressing FDG-avid sites where confirmation is needed.

RiscoWorst response category — active, progressing lymphoma carrying the least favourable prognosis among the response groups.

verificadoRecommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma (Lugano)PMC4979083 Table 3 'Revised Criteria for Response Assessment', Progressive Disease row (PET 5PS score 4-5 with increased intensity from baseline and/or new foci; CT individual node 'Increase by >=50% from PPD nadir' plus absolute size-increase criteria; new lesions)

Lógica de decisão estruturada

{
  "categories": [
    "CMR",
    "PMR",
    "SD",
    "PMD"
  ]
}

Referência, não é dispositivo médico. Confira a publicação primária vigente. O radiologista que assina o laudo continua autor e responsável.