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Ann Arbor staging is the staging system for lymphomas, both in Hodgkin's lymphoma (formerly designated Hodgkin's disease) and non-Hodgkin lymphoma (abbreviated NHL). It was initially developed for Hodgkin's, but has some use in NHL. It has roughly the same function as TNM staging in solid tumors. The stage depends on both the place where the malignant tissue is located (as located with biopsy,
CT scan A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...
ning, gallium scan and increasingly
positron emission tomography Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in Metabolism, metabolic processes, and in other physiological activities including bl ...
) and on systemic symptoms due to the lymphoma (" B symptoms": night sweats, weight loss of >10% or fevers).


Principal stages

The principal stage is determined by location of the tumor: * ''Stage I'' indicates that the cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms. * ''Stage II'' indicates that the cancer is located in two separate regions, an affected lymph node or lymphatic organ and a second affected area, and that both affected areas are confined to one side of the diaphragm—that is, both are above the diaphragm, or both are below the diaphragm. * ''Stage III'' indicates that the cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen. * ''Stage IV'' indicates diffuse or disseminated involvement of one or more extralymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs.


Modifiers

These letters can be appended to some stages: * ''A'' or ''B:'' the absence of constitutional ( B-type) symptoms is denoted by adding an "A" to the stage; the presence is denoted by adding a "B" to the stage. * ''S:'' is used if the disease has spread to the spleen. * ''E:'' is used if the disease is "extranodal" (not in the
lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inclu ...
s) or has spread from lymph nodes to adjacent tissue. * ''X:'' is used if the largest deposit is >10 cm large ("bulky disease"), or whether the
mediastinum The mediastinum (from ) is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is an undelineated region that contains a group of structures within the thorax, namely the heart and its vessels, the esophagu ...
is wider than â…“ of the chest on a
chest X-ray A chest radiograph, called a chest X-ray (CXR), or chest film, is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most common film taken in med ...
.


Type of staging

The nature of the staging is (occasionally) expressed with: * ''CS'': clinical stage as obtained by doctor's examinations and tests. * ''PS'': pathological stage as obtained by exploratory laparotomy (surgery performed through an abdominal incision) with splenectomy (surgical removal of the spleen). Note: exploratory laparotomy has fallen out of favor for lymphoma staging.


Limitations

The staging does not take into account the ''grade'' (biological behavior) of the tumor tissue. The prognostic significance of bulky disease, and some other modifiers, were introduced with the "Cotswolds modification".


History

The Ann Arbor classification is named after
Ann Arbor Anne, alternatively spelled Ann, is a form of the Latin female given name Anna (name), Anna. This in turn is a representation of the Hebrew Hannah (given name), Hannah, which means 'favour' or 'grace'. Related names include Annie (given name), ...
, Michigan, where the Committee on Hodgkin's Disease Staging Classification met in 1971; it consisted of experts from the United States, UK, Germany and France, and replaced the older Rye classification from a 1965 meeting. The Cotswolds modification followed after a 1988 meeting in the UK
Cotswolds The Cotswolds (, ) is a region in central-southwest England, along a range of rolling hills that rise from the meadows of the upper Thames to an escarpment above the Severn Valley and Evesham Vale. The area is defined by the bedrock of Jur ...
.


References


Further reading

* {{Tumors Anatomical pathology Cancer staging Lymphoma