Deauville score and PET-adapted therapy

Overview

• What the scale cannot do. A score of 3, uptake above the mediastinum but at or below the liver, is deliberately ambiguous: in a de-escalation trial it is usually treated as a good response and in an escalation trial as an inadequate one, so the same scan leads to opposite decisions depending on the protocol, and a patient told their score is 3 has been told less than they think. Inflammation, infection, granulomatous disease, brown fat and recent growth-factor support all take up the tracer. Indolent lymphomas are variably avid, so the scale is least useful where disease is most likely to be left behind. The Lugano classification, which incorporated PET-CT formally into staging for avid lymphomas, also removed the routine staging bone marrow biopsy for Hodgkin lymphoma and most diffuse large B-cell lymphoma (Cheson 2014, Barrington 2014).