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Lugano and Paris staging systems for gastrointestinal lymphomas

Lugano and Paris staging systems for gastrointestinal lymphomas
Paris staging system for primary gastrointestinal lymphomas*[1]
Primary tumor (T)
TX Lymphoma extent not specified
T0 No evidence of lymphoma
T1 Lymphoma confined to the mucosa/submucosa
T1m Lymphoma confined to the mucosa
T1sm Lymphoma confined to the submucosa
T2 Lymphoma infiltrates muscularis propria or subserosa
T3 Lymphoma penetrates serosa (visceral peritoneum) without invasion of adjacent structures
T4 Lymphoma invades adjacent structures or organs
Regional lymph node involvement (N)
NX Involvement of lymph nodes not assessed
N0 No evidence of lymph node involvement
N1Δ Involvement of regional lymph nodes
N2 Involvement of intra-abdominal lymph nodes beyond the regional area
N3 Spread to extra-abdominal lymph nodes
Distant metastasis (M)
MX Dissemination of lymphoma not assessed
M0 No evidence of extranodal dissemination
M1 Non-continuous involvement of separate site in gastrointestinal tract (eg, stomach and rectum)
M2 Non-continuous involvement of other tissues (eg, peritoneum, pleura) or organs (eg, tonsils, parotid gland, ocular adnexa, lung, liver, spleen, kidney, breast)
Bone marrow involvement (B)
BX Involvement of bone marrow not assessed
B0 No evidence of bone marrow involvement
B1 Lymphomatous infiltration of bone marrow
Application
TNM Clinical staging: status of tumor, node, metastasis, bone marrow
pTNMB Histopathological staging: status of tumor, node, metastasis, bone marrow
pN The histological examination will ordinarily include 6 or more lymph nodes
Lugano staging system for gastrointestinal lymphomas[2]
Stage I - The tumor is confined to the gastrointestinal tract. It can be a single primary lesion or multiple, noncontiguous lesions. (Corresponds to Paris stage T1-3 N0 M0.)
Stage II - The tumor extends into the abdomen. This is further subdivided based upon the location of nodal involvement:
  • Stage II1: Involvement of local nodes (paragastric nodes for gastric lymphoma or para-intestinal nodes for intestinal lymphoma). (Corresponds to Paris stage T1-3 N1 M0.)
  • Stage II2: Involvement of distant nodes (para-aortic, para-caval, pelvic, or inguinal nodes for most tumors; mesenteric nodes in the case of intestinal lymphoma). (Corresponds to Paris stage T1-3 N2 M0.)
  • Stage IIE: The tumor penetrates the serosa to involve adjacent organs or tissues. (Corresponds to Paris stage T4 N0-2 M0.)
Stage III - There is no stage III disease in this system.
Stage IV - There is disseminated extranodal involvement or concomitant supra-diaphragmatic nodal involvement. (Corresponds to Paris stage T1-4 N3 M0 or T1-4 N0-3 M1-2.)
* Valid for lymphomas originating from the gastro-esophageal junction to the anus (as defined by identical histomorphological structure).
¶ In case of more than one visible lesion synchronously originating in the gastrointestinal tract, give the characteristics of the more advanced lesion.
Δ Anatomical designation of lymph nodes as "regional" according to site:
  • Stomach: perigastric nodes and those located along the ramifications of the coeliac artery (that is, left gastric artery, common hepatic artery, splenic artery) in accordance with compartments I and II of the Japanese Research Society for Gastric Cancer (1995).
  • Duodenum: pancreaticoduodenal, pyloric, hepatic, and superior mesenteric nodes.
  • Jejunum/ileum: mesenteric nodes and, for the terminal ileum only, the ileocolic as well as the posterior caecal nodes.
  • Colorectum: pericolic and perirectal nodes and those located along the ileocolic, right, middle, and left colic, inferior mesenteric, superior rectal, and internal iliac arteries.
References:
  1. Reproduced with permission from: Ruskoné-Fourmestraux A, Dragosics B, Morgner A, et al. Paris staging system for primary gastrointestinal lymphomas. Gut 2003; 52(6):912-913. Copyright © 2003 BMJ Publishing Group Ltd.
  2. Rohatiner A, d'Amore F, Coiffier B, et al. Report on a workshop convened to discuss the pathological and staging classification of gastrointestinal tract lymphoma. Ann Oncol 1994; 5:397. Copyright © 1994 Oxford University Press.
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