The Deauville Score (DS) is a standardized, five-point visual grading system used in oncology to evaluate how tumors respond to treatment. It provides a common language for medical professionals to interpret imaging results worldwide, ensuring consistency in patient care and clinical trial reporting. This scale aids doctors in assessing the metabolic activity of residual disease following therapy. The score is particularly useful for measuring the effectiveness of chemotherapy and determining the next steps in a patient’s care plan.
Measuring Metabolic Activity
The methodology behind assigning the Deauville Score relies on a specialized imaging technique called Positron Emission Tomography (PET) scanning. This scan utilizes a radioactive tracer called fluorodeoxyglucose (FDG), which is a glucose analog that is taken up by metabolically active cells, including most lymphoma cells. Since cancer cells generally exhibit higher metabolic rates than normal cells, they absorb more FDG, causing them to “light up” on the resulting PET image.
The score is assigned by visually comparing the FDG uptake intensity in the suspicious tumor site against two standardized, non-cancerous reference points within the patient’s body. The first reference point is the mediastinal blood pool, which serves as a baseline for normal background blood activity. The second, higher reference point is the uptake observed in the normal liver tissue, which naturally shows moderate FDG activity.
Radiologists compare the brightness of the area in question to these two fixed points to determine the score. This qualitative, visual assessment allows for a rapid, standardized report of the tumor’s current metabolic activity.
Breakdown of the Five-Point Scale
The Deauville Score consists of five distinct numerical grades, each defined by how the tumor’s FDG uptake compares to the reference organs. A score of 1 indicates the best outcome, where the lesion shows no FDG uptake above the general background activity. A score of 2 is assigned when the uptake in the lesion is present but is less than or equal to the uptake seen in the mediastinal blood pool.
The middle score, Deauville 3, signifies that the uptake in the residual tumor is greater than the mediastinum but remains less than or equal to the uptake found in the normal liver tissue. This level is considered equivocal and is interpreted based on the specific lymphoma type and the clinical context. Scores 1, 2, and 3 suggest a favorable metabolic response.
A score of 4 indicates that the tumor’s FDG uptake is moderately increased compared to the normal liver tissue. This suggests residual disease is likely present and that the current treatment may not be completely effective. A score of 5 represents the highest metabolic activity, where the uptake is markedly or intensely greater than that of the liver, sometimes defined as two to three times more intense.
In addition to the five numerical scores, an auxiliary classification, denoted as “X,” may be used. This designation applies to new areas of FDG uptake that appear on the scan but are unlikely to be related to the patient’s lymphoma. Examples of score X findings might include incidental inflammatory conditions or other benign hypermetabolic activity.
Clinical Use in Lymphoma Treatment
The Deauville Score is used within the Lugano Classification, which provides international guidelines for managing Hodgkin lymphoma (HL) and most FDG-avid non-Hodgkin lymphomas (NHL). It is used at several distinct points during the patient’s care journey: for initial staging, as an interim assessment during treatment, and for final response evaluation at the end of therapy. The score allows physicians to stratify patients into different prognostic groups and make timely adjustments to their chemotherapy regimens.
The interim assessment, performed after only a few cycles of chemotherapy, reveals how sensitive the lymphoma is to the current drugs. Scores of 1, 2, or, in some contexts, 3 are grouped together to define a complete metabolic response (CMR). A CMR indicates that the treatment has successfully eradicated the metabolically active tumor cells and is associated with a more favorable prognosis.
Conversely, an interim score of 4 or 5 indicates a poor metabolic response to the treatment. This outcome serves as a prognostic indicator that the current therapy is insufficient. This prompts the medical team to consider a change in chemotherapy or an escalation of the treatment plan, especially for aggressive lymphomas.
At the end of treatment, the score is used to establish the patient’s remission status. A final score of 1 or 2 is the most desired outcome, confirming a complete metabolic response, even if a non-active residual mass remains visible on the CT portion of the scan. For scores of 4 or 5 at the end of treatment, the clinical team must assess whether the uptake has decreased, remained stable, or increased compared to previous scans. This assessment classifies the result as a partial response, no metabolic response, or progressive disease, respectively.