# Deauville 5PS — Deauville five-point FDG-PET scale for lymphoma

> Lesion-level visual FDG-uptake score relative to mediastinal blood pool and liver: 1 no uptake, 2 at or below mediastinum, 3 above mediastinum but at or below liver, 4 moderately above liver and 5 markedly above liver and/or new lymphoma-consistent sites. X is a nonordinal qualifier for uptake unlikely to be lymphoma. Response requires baseline change, timepoint and patient-level synthesis; a score alone is not progression, a treatment order or an individualized prognosis.

**Situação:** vigente · **Órgão:** Oncologia · **Órgão emissor:** International lymphoma imaging consensus · **Versão:** 2009 scale; Lugano 2014 and PRoLoG 2023 operationalization; status reviewed 2025 · **Ano:** 2009

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: FDG PET/CT
- Fonte primária: Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on interim-PET scan in lymphoma (Deauville criteria) (2009) — https://doi.org/10.1080/10428190903040048
- Última verificação: 2026-07-24
- Última checagem: 2026-07-24

## Lógica de decisão
Score lesions against valid mediastinal and liver references, then synthesize longitudinal response; never equate a bare 4 or 5 with progression or a treatment order.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 1 | Score 1, no uptake | No abnormal FDG uptake attributable to lymphoma above background. Confirm baseline FDG avidity, technical comparability and that apparently absent uptake is not caused by an unsuitable study. | Within standard Lugano response assessment, score 1 contributes to complete metabolic response. Continue or change therapy only according to the declared lymphoma protocol, response timepoint, clinical state and multidisciplinary review; the numeral itself is not an order. | Score 1 is metabolically negative under the applicable framework but does not guarantee cure or zero residual microscopic disease. It carries no universal patient-level progression-free-survival probability. | Meignan et al. 2009, DOI 10.1080/10428190903040048, five-point definitions; Cheson et al. 2014, DOI 10.1200/JCO.2013.54.8800, PET response table; PRoLoG 2023 for technical application. | ✓ |
| 2 | Score 2, uptake at or below mediastinum | Lesion FDG uptake is at or below the mediastinal blood-pool reference on the same examination, with a technically valid mediastinal reference and uptake attributable to the evaluated lesion. | Score 2 contributes to complete metabolic response under standard Lugano, with or without a residual mass. Any protocol-specific de-escalation or escalation rule must be named and applied separately from the visual score. | Score 2 is within the standard metabolically negative range but is not a calibrated recurrence probability. Outcome meaning still depends on lymphoma subtype, treatment line, timepoint and protocol. | Meignan et al. 2009, original reference-region scale; Cheson et al. 2014, Lugano PET response table; Barrington et al. 2023, PMC9902846, reference-region and response implementation. | ✓ |
| 3 | Score 3, above mediastinum up to liver | Lesion FDG uptake is above mediastinal blood pool but at or below the normal liver reference. Uptake equal to liver remains score 3 rather than score 4. | Standard Lugano treats score 3 as complete metabolic response. A treatment-de-escalation trial may predeclare a stricter cutoff, but the agent must name that protocol and must not silently redefine score 3 as positive. | Score 3 usually lies in the standard complete-response range, yet its trial-specific action and cohort association vary. It is neither universally positive nor a patient-specific relapse estimate. | Meignan et al. 2009, five-point scale; Cheson et al. 2014, standard scores 1-3 CMR; PRoLoG 2023, PMC9902846, protocol and technical clarifications. | ✓ |
| 4 | Score 4, moderately above liver | Lesion FDG uptake is moderately greater than normal liver uptake. Preserve the qualitative comparison, reference validity, lesion identity and change from baseline or nadir. | Score 4 requires longitudinal synthesis: reduced uptake is partial metabolic response, unchanged uptake is no metabolic response, and increased uptake or qualifying new disease can be progressive metabolic disease. At interim versus end of treatment, the same reduced score-4 uptake has different response wording. Do not change treatment from the bare score. | Score 4 is metabolically positive under standard interpretation but does not itself prove viable lymphoma, progression or treatment failure. Confounding inflammation and the full longitudinal pattern determine meaning; no universal outcome percentage applies. | Cheson et al. 2014, DOI 10.1200/JCO.2013.54.8800, Lugano response table distinguishing PMR, no response and PMD; PRoLoG 2023 for technical and longitudinal application. | ✓ |
| 5 | Score 5, markedly above liver or new lesions | Lesion FDG uptake is markedly greater than normal liver and/or there is a new FDG-avid site whose distribution and appearance are consistent with lymphoma. A new focus unlikely to represent lymphoma is qualified X instead of automatically scored as progression. | Like score 4, score 5 must be compared with baseline or nadir and adjudicated for new-site cause before assigning partial response, no response or progression. Correlate an uncertain new focus with anatomy, timing, follow-up or tissue sampling when it would change care; the score does not autonomously select therapy. | Score 5 indicates the strongest visual metabolic abnormality in the current scale but is not histologic confirmation or a calibrated prognosis. A proposed two-times-liver threshold and 5a/5b split remain future clarifications unless an adopted protocol explicitly invokes them. | Meignan et al. 2009, original score 5 and X concepts; Lugano 2014 response table; PRoLoG 2023 operational guidance; Barrington et al. 2025, DOI 10.1002/hon.70103, current standard and proposal boundary. | ✓ |

### Citações por categoria
- **1**: Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on interim-PET scan in lymphoma (Deauville criteria) (2009) — https://doi.org/10.1080/10428190903040048 · Meignan et al. 2009, DOI 10.1080/10428190903040048, five-point definitions; Cheson et al. 2014, DOI 10.1200/JCO.2013.54.8800, PET response table; PRoLoG 2023 for technical application.
- **2**: Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on interim-PET scan in lymphoma (Deauville criteria) (2009) — https://doi.org/10.1080/10428190903040048 · Meignan et al. 2009, original reference-region scale; Cheson et al. 2014, Lugano PET response table; Barrington et al. 2023, PMC9902846, reference-region and response implementation.
- **3**: Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on interim-PET scan in lymphoma (Deauville criteria) (2009) — https://doi.org/10.1080/10428190903040048 · Meignan et al. 2009, five-point scale; Cheson et al. 2014, standard scores 1-3 CMR; PRoLoG 2023, PMC9902846, protocol and technical clarifications.
- **4**: Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on interim-PET scan in lymphoma (Deauville criteria) (2009) — https://doi.org/10.1080/10428190903040048 · Cheson et al. 2014, DOI 10.1200/JCO.2013.54.8800, Lugano response table distinguishing PMR, no response and PMD; PRoLoG 2023 for technical and longitudinal application.
- **5**: Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on interim-PET scan in lymphoma (Deauville criteria) (2009) — https://doi.org/10.1080/10428190903040048 · Meignan et al. 2009, original score 5 and X concepts; Lugano 2014 response table; PRoLoG 2023 operational guidance; Barrington et al. 2025, DOI 10.1002/hon.70103, current standard and proposal boundary.

## Referências cruzadas
- _caracteriza_ → [Lugano — Lugano classification for lymphoma response](https://radcommons.laudos.ai/systems/lugano.md) — Deauville is the lesion-level FDG visual score used inside Lugano metabolic-response synthesis. A bare score 4 or 5 cannot distinguish partial response, no response and progression without baseline change and timepoint.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2025-01-01 | revised | The current-status consensus confirmed Lugano 2014 remains standard and framed proposed score-5 clarifications as future revisions rather than current replacements. | confirmed |
| 2023-01-01 | revised | PRoLoG published operational clarifications for applying Lugano and Deauville consistently; this did not create a new Deauville version. | confirmed |
| 2014-09-01 | revised | Lugano incorporated the Deauville five-point scale into longitudinal lymphoma metabolic-response assessment without changing its lesion-level reference definitions. | confirmed |
| 2009-08-01 | published | The first international Deauville workshop published the five-point visual FDG-uptake scale using mediastinal and liver references. | confirmed |


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