Standardized scoring systems play a significant role in modern oncology, providing a common language for physicians to assess how a patient is responding to therapy. These tools help translate complex imaging results into understandable metrics that guide treatment decisions. The Deauville Score (DS) is one such system, designed to evaluate the metabolic activity of tumors following treatment. This score is particularly used in lymphomas to determine whether the therapy has been successful in eliminating the disease’s activity. A Deauville Score of 5 can understandably cause concern, and understanding what this number represents requires a look at the imaging technology used to generate it.
Understanding the Deauville Score and FDG-PET Scans
The Deauville Score is a standardized visual assessment tool used in conjunction with Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) scans. This imaging technique utilizes a radioactive glucose analog, FDG, which is injected into the patient’s bloodstream. Cancer cells consume glucose at a higher rate than most normal cells, causing them to “light up” on the PET scan where the FDG tracer accumulates.
The DS is used primarily to gauge treatment response in Hodgkin lymphoma and certain non-Hodgkin lymphomas. It assesses the degree of FDG uptake, which corresponds to the metabolic activity remaining in the previously diseased sites. The strength of the tracer uptake in the suspected tumor site is visually compared to two internal reference points: the mediastinal blood pool and the liver.
Using the patient’s own body as a benchmark, the DS provides a consistent and reproducible method for interpreting results. The mediastinum, which contains large blood vessels, and the liver have relatively constant levels of background FDG activity. The interpretation of the tumor site’s activity relative to these organs determines the final score.
Interpreting Scores 1 Through 5
The Deauville Score is an ordinal scale ranging from 1 to 5, with lower scores indicating a more favorable response to treatment. Scores of 1, 2, and 3 are generally associated with a positive outcome, often signifying a complete metabolic response. This means the therapy appears to have eliminated the cancer’s metabolic activity.
A score of 1 indicates no uptake of the FDG tracer above the background activity, while a score of 2 shows uptake that is less than or equal to the blood pool in the mediastinum. Both scores are considered negative for residual disease and represent an excellent treatment outcome. A score of 3 means the uptake is greater than the mediastinum but remains less than or equal to the liver’s normal activity. While this score is often categorized as a complete metabolic response, it may require clinical correlation.
Scores of 4 and 5 are generally considered positive for residual or active disease, suggesting an incomplete or poor response to the initial treatment. A score of 4 means the FDG uptake in the tumor site is moderately higher than the activity seen in the liver. This result suggests residual disease and is often classified as a partial metabolic response.
A score of 5 indicates the most intense level of activity, where the tracer uptake is markedly higher than the liver. This high level of metabolic activity is a strong indicator of residual, refractory, or progressive disease. A score of 5 may also be assigned if new areas of FDG-avid disease are identified on the post-treatment scan.
What a Deauville Score of 5 Means for Treatment
A Deauville Score of 5 requires immediate attention, as it is a strong indication that the current treatment regimen has not been effective. This score signifies highly active, residual malignant tissue, meaning the cancer cells are still metabolically robust and consuming significant amounts of glucose. Clinically, a DS 5 is associated with a considerably increased risk of relapse or treatment failure compared to patients with lower scores.
This result strongly suggests the disease is either refractory, meaning it did not respond to the therapy, or that it has progressed despite treatment. The high intensity of the FDG uptake reflects an aggressive biological state of the remaining disease.
Receiving a DS 5 result typically triggers a necessary shift in the patient’s management plan. The oncologist will usually recommend a change in treatment strategy, which may involve switching to a different, more intensive chemotherapy regimen, sometimes referred to as salvage therapy. Other options considered may include consolidation with high-dose chemotherapy followed by a stem cell transplant or enrollment in a relevant clinical trial.
The DS 5 is a signal for the medical team to perform further testing and engage in a discussion with the patient about next steps. While this score is challenging news, it provides clear, actionable information that guides the selection of more appropriate and aggressive second-line treatments designed to target the persistent disease.