Question 1

What are B symptoms and why are they important?

Accepted Answer

B symptoms — fever >38°C, drenching night sweats, and unexplained weight loss >10% over 6 months — are independent adverse prognostic factors. Their presence upstages the prognosis and may alter treatment (e.g., adding chemotherapy for otherwise early-stage disease).

Question 2

How does PET-CT change Ann Arbor staging?

Accepted Answer

PET-CT can upstage or downstage compared to CT alone by detecting occult extranodal disease or confirming that a suspicious CT lesion is not metabolically active. The Lugano Classification incorporates PET-CT findings into the Ann Arbor framework.

Question 3

Is Ann Arbor staging used for all lymphomas?

Accepted Answer

Ann Arbor is primarily used for Hodgkin lymphoma and aggressive B-cell NHL. For indolent lymphomas (e.g., CLL/SLL, follicular lymphoma grade 1–2), the staging system is still used but treatment decisions are more influenced by disease burden, symptoms, and histological grade.

Question 4

What is the role of bone marrow biopsy in staging?

Accepted Answer

Bone marrow biopsy is recommended for all Hodgkin lymphoma patients with B symptoms or advanced-stage disease, and for most NHL subtypes. PET-CT can now replace bone marrow biopsy in Hodgkin lymphoma when the marrow is PET-negative.