Deauville Scoring in Lymphoma
Two reference organs, five points: is the lymphoma still alive?
A mass left after chemotherapy can be scar or tumour. Deauville settles it with one number, by comparing the hottest residual lesion with the mediastinum and the liver.
The scale
- Low reference — mediastinal blood pool (aortic arch).
- High reference — liver (normal right lobe).
- Score the hottest residual lesion. Read visually; use SUVmax only when borderline.
| Score | Hottest residual lesion | Meaning |
|---|---|---|
| 1 | No uptake | CMR |
| 2 | ≤ mediastinum | CMR |
| 3 | > mediastinum, ≤ liver | CMR (usually) |
| 4 | Moderately > liver | Residual disease |
| 5 | Markedly > liver and/or new lesions | Residual or progressive disease |
CMR = complete metabolic response.
Remember
“1-2-3, disease-free; 4-5, still alive.” Climb the ladder: nothing, blood pool, liver, above, far above.
Score to response (Lugano 2014)
| Deauville | Compared with baseline | Response |
|---|---|---|
| 1–3 | Any residual mass | Complete metabolic response |
| 4–5 | Uptake reduced | Partial metabolic response |
| 4–5 | No change | No metabolic response |
| 4–5 | Uptake increased, or new lesions | Progressive disease |
Score 3 is the grey zone. CMR in routine care; may count as inadequate in de-escalation trials. Report the number.
Timing and pitfalls
Timing
- Interim — just before the next cycle.
- End of treatment — ≥3 weeks after chemotherapy (ideally 6–8), or ≥3 months after radiotherapy.
Pitfalls
- False positives: thymic rebound, brown fat, inflammation, marrow and spleen after G-CSF.
- Immunotherapy: flare can mimic progression (LYRIC criteria).
- Low-avid types: small lymphocytic, marginal zone — use CT instead.
The measured version: qPET.
Take home
- Score the hottest residual lesion against mediastinum and liver, 1 to 5.
- 1–3 is CMR even with a residual mass. With 4–5, baseline comparison decides the response.
- Score 3 is the grey zone. Time scans correctly to avoid inflammatory false positives.
Sources
- Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on Interim-PET-Scan in Lymphoma. Leuk Lymphoma. 2009;50(8):1257-60.
- 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):3059-68.
- Barrington SF, Mikhaeel NG, Kostakoglu L, et al. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol. 2014;32(27):3048-58.
- Cheson BD, Ansell S, Schwartz L, et al. Refinement of the Lugano Classification lymphoma response criteria in the era of immunomodulatory therapy. Blood. 2016;128(21):2489-96.