Deauville five-point scale

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The Deauville five-point scale (Deauville 5ps) is an internationally recommended ~~scale~~ scale for ~~initial~~clinical routine and clinical trials using FDG-PET/CT in the initial staging and ~~evaluation~~assessment of ~~respons~~treatment respons in Hodgkin lymphoma (HL) and certain types of non-Hodgkin lymphomas (NHL).

Inclusions

FDG-PET/CT for staging and treatment response in both clinical routine and clinical trials using the Deauville 5ps is recommended in ²:

Hodgkin lymphoma (HL), any type
diffuse large B cellular lymphoma (DLBCL)
Marginal zone NHL with aggressive transformation
FDG-avid nodal lymphomas, essentially all histologic types except:
- chronic lymphocytic leukemia (CLL)
- small lymphocytic lymphoma
- lymphoplasmocytic lymphoma
- Waldenström´s macroglobulinaemia
- mycosis fungoides

whereas there have been proposed separate criteria for ²

primary extranodal and
cutaneous lymphomas

Usage

It is a simple tool based on visual interpretation of FDG-uptake. It takes advantage of two reference points of the individual patient, which have demonstrated relatively constant uptake on serial imaging. The two reference organs are the mediastinum (aka blood-pool) and the liver.

The scale ranges from 1 to 5, where 1 is best and 5 is the worst. Each FDG-avid (or previously FDG-avid) lesion is rated independently.

no uptake or no residual uptake (when used interim)
slight uptake, but below blood-pool (mediastinum)
uptake above mediastinal, but below or equalling uptake in the liver
uptake slightly higher than liver
markedly increased uptake or any new lesion (on response evaluation)

Some authors also use

X for any lesion not overtly attributable to lymphoma

Assessment of treatment respons

Complete response (CR):Scores 1,2 or 3 together with absence of FDG-avid bone marrow lesion(s) are interpreted as complete metabolic response (CR), irrespective of a persistent mass on CT
Partial response (PR):A Deauville score of 4 or 5, however:
- uptake decreased compared with baseline and
- absence of structural progression development on CT
Stable disease (SD), also called no metabolic response:A Deauville score of 4 or 5 without significant change in FDG uptake from baseline.
Progressive disease (PD):A Deauville score of 4 to 5 with increasing intensity compared to baseline or any interim scan and/or any new FDG-avid focus consistent with malignant lymphoma.

History and etymology

The scale was proposed in an international workshop attended by hematologists and nuclear medicine experts in Deauville, France in 2009 ^4-5.

-<p>The <strong>Deauville five-point scale (Deauville 5ps) </strong>is an internationally recommended scale for initial staging and evaluation of respons in <a title="Hodgkin lymphoma" href="/articles/hodgkin-lymphoma">Hodgkin lymphoma</a> and certain types of <a title="" href="/articles/">non-Hodgkin lymphomas</a> (NHL).</p>
+<p>The <strong>Deauville five-point scale (Deauville 5ps) </strong>is an internationally recommended scale for clinical routine and clinical trials using FDG-PET/CT in the initial staging and assessment of treatment respons in <a href="/articles/hodgkin-lymphoma">Hodgkin lymphoma</a> (HL) and certain types of <a href="/articles/">non-Hodgkin lymphomas</a> (NHL). </p><h4>Inclusions</h4><p>FDG-PET/CT for staging and treatment response in both clinical routine and clinical trials using the Deauville 5ps is recommended in <sup>2</sup>:</p><ul>
+<li>Hodgkin lymphoma (HL), any type</li>
+<li>diffuse large B cellular lymphoma (DLBCL)</li>
+<li>Marginal zone NHL with aggressive transformation</li>
+<li>FDG-avid nodal lymphomas, essentially <strong>all histologic types except</strong>:<ul>
+<li>
+<a title="Chronic lymphocytic leukemia" href="/articles/chronic-lymphocytic-leukaemia">chronic lymphocytic leukemia</a> (CLL)</li>
+<li>small lymphocytic lymphoma</li>
+<li>lymphoplasmocytic lymphoma</li>
+<li>Waldenström´s macroglobulinaemia</li>
+<li>mycosis fungoides</li>
+</ul>
+</li>
+</ul><p>whereas there have been proposed separate criteria for <sup>2</sup></p><ul>
+<li>primary extranodal and</li>
+<li>cutaneous lymphomas</li>
+</ul><h4>Usage</h4><p>It is a simple tool based on visual interpretation of FDG-uptake. It takes advantage of two reference points of the individual patient, which have demonstrated relatively constant uptake on serial imaging. The two reference organs are the mediastinum (aka blood-pool) and the liver. </p><p>The scale ranges from 1 to 5, where 1 is best and 5 is the worst. Each FDG-avid (or previously FDG-avid) lesion is rated independently.</p><ol>
+<li>no uptake or no residual uptake (when used interim) </li>
+<li>slight uptake, but below blood-pool (mediastinum) </li>
+<li>uptake above mediastinal, but below or equalling uptake in the liver</li>
+<li>uptake slightly higher than liver</li>
+<li>markedly increased uptake or any new lesion (on response evaluation)</li>
+</ol><p>Some authors also use</p><ul><li>X for any lesion not overtly attributable to lymphoma</li></ul><h5>Assessment of treatment respons</h5><ul>
+<li>Complete response (CR):<br>Scores 1,2 or 3 together with absence of FDG-avid bone marrow lesion(s) are interpreted as complete metabolic response (CR), irrespective of a persistent mass on CT</li>
+<li>Partial response (PR):<br>A Deauville score of 4 or 5, however: <ul>
+<li>uptake decreased compared with baseline and</li>
+<li>absence of structural progression development on CT</li>
+</ul>
+</li>
+<li>Stable disease (SD), also called no metabolic response:<br>A Deauville score of 4 or 5 without significant change in FDG uptake from baseline. </li>
+<li>Progressive disease (PD):<br>A Deauville score of 4 to 5 with increasing intensity compared to baseline or any interim scan and/or any new FDG-avid focus consistent with malignant lymphoma.</li>
+</ul><p> </p><h4>History and etymology</h4><p>The scale was proposed in an international workshop attended by hematologists and nuclear medicine experts in <strong>Deauville</strong>, France in 2009 <sup>4-5</sup>. </p>

References changed:

3. Gallamini A, Barrington S, Biggi A et al. The Predictive Role of Interim Positron Emission Tomography for Hodgkin Lymphoma Treatment Outcome is Confirmed Using the Interpretation Criteria of the Deauville Five-Point Scale. Haematologica. 2014;99(6):1107-13. <a href="https://doi.org/10.3324/haematol.2013.103218">doi:10.3324/haematol.2013.103218</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24658820">Pubmed</a>
1. Barrington S, Mikhaeel N, 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. <a href="https://doi.org/10.1200/JCO.2013.53.5229">doi:10.1200/JCO.2013.53.5229</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25113771">Pubmed</a>
2. Cheson B, Fisher R, Barrington S 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. <a href="https://doi.org/10.1200/JCO.2013.54.8800">doi:10.1200/JCO.2013.54.8800</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25113753">Pubmed</a>
4. Biggi A, Gallamini A, Chauvie S et al. International Validation Study for Interim PET in ABVD-Treated, Advanced-Stage Hodgkin Lymphoma: Interpretation Criteria and Concordance Rate Among Reviewers. J Nucl Med. 2013;54(5):683-90. <a href="https://doi.org/10.2967/jnumed.112.110890">doi:10.2967/jnumed.112.110890</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23516309">Pubmed</a>
5. Barrington S, Qian W, Somer E et al. Concordance Between Four European Centres of PET Reporting Criteria Designed for Use in Multicentre Trials in Hodgkin Lymphoma. Eur J Nucl Med Mol Imaging. 2010;37(10):1824-33. <a href="https://doi.org/10.1007/s00259-010-1490-5">doi:10.1007/s00259-010-1490-5</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/20505930">Pubmed</a>

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