Initial assessment of MZLs
| MZL subtype and anatomical site . | Staging . |
|---|---|
| All MZLs | Familial and individual history Physical examination with PS and B symptoms Lab: complete blood and differential counts, lactate dehydrogenase, beta-2-microglobulin, renal and liver function, protein electrophoresis, serum and urine immunofixation Viral serologies: complete HBV markers, HIV and HCV serologies (if HCV positive, HCV-RNA and genotype; cryoglobulins and cryocrit) Direct Coombs' test (if clinically indicated, especially in SMZL) Bone marrow biopsy in SMZL and NMZL (recommended in EMZL, particularly nongastric, if cytopenias are present or only local treatment is planned) CT of the neck, chest, abdomen, and pelvis MRI in specific situations PET/CT when only local treatment is planned and to identify biopsy site if clinical or laboratory data suggest histologic transformation |
| NMZL | Flow cytometry (bone marrow and peripheral blood) |
| SMZL | Flow cytometry (bone marrow and peripheral blood) |
| Stomach | Esophagogastroduodenoscopy Endoscopic ultrasonography (optional) Helicobacter pylori status by IHC (mandatory) (if IHC negative fecal antigen or breath test and serology studies) FISH or PCR assay for the t(11;18) translocation (optional) |
| Small intestine | Campylobacter jejuni status (PCR, IHC, or ISH) |
| Colon | Colonoscopy Esophagogastroduodenoscopy |
| Salivary glands | MRI of head and neck ENT examination and ultrasonography Esophagogastroduodenoscopy anti-SSA/Ro and anti-SSB/La antibodies |
| Ocular adnexa | Head and neck and orbit imaging Ophthalmologic examination Chlamydophila psittaci status (PCR) in the tumor biopsy, conjunctival swab, and PBMCs (optional, geographic variability) anti-SSA/Ro and anti-SSB/La antibodies (lacrimal gland) |
| Lung | Bronchoscopy and bronchoalveolar lavage Esophagogastroduodenoscopy (optional) |
| Breast | Mammography Breast ultrasonography MRI (or CT scan) of breast |
| Thyroid | Thyroid ultrasonography Thyroid function tests |
| Central nervous system (dura mater) | MRI of brain |
| Skin | Borrelia burgdorferi status (PCR) in the tumor biopsy (optional) |
| MZL subtype and anatomical site . | Staging . |
|---|---|
| All MZLs | Familial and individual history Physical examination with PS and B symptoms Lab: complete blood and differential counts, lactate dehydrogenase, beta-2-microglobulin, renal and liver function, protein electrophoresis, serum and urine immunofixation Viral serologies: complete HBV markers, HIV and HCV serologies (if HCV positive, HCV-RNA and genotype; cryoglobulins and cryocrit) Direct Coombs' test (if clinically indicated, especially in SMZL) Bone marrow biopsy in SMZL and NMZL (recommended in EMZL, particularly nongastric, if cytopenias are present or only local treatment is planned) CT of the neck, chest, abdomen, and pelvis MRI in specific situations PET/CT when only local treatment is planned and to identify biopsy site if clinical or laboratory data suggest histologic transformation |
| NMZL | Flow cytometry (bone marrow and peripheral blood) |
| SMZL | Flow cytometry (bone marrow and peripheral blood) |
| Stomach | Esophagogastroduodenoscopy Endoscopic ultrasonography (optional) Helicobacter pylori status by IHC (mandatory) (if IHC negative fecal antigen or breath test and serology studies) FISH or PCR assay for the t(11;18) translocation (optional) |
| Small intestine | Campylobacter jejuni status (PCR, IHC, or ISH) |
| Colon | Colonoscopy Esophagogastroduodenoscopy |
| Salivary glands | MRI of head and neck ENT examination and ultrasonography Esophagogastroduodenoscopy anti-SSA/Ro and anti-SSB/La antibodies |
| Ocular adnexa | Head and neck and orbit imaging Ophthalmologic examination Chlamydophila psittaci status (PCR) in the tumor biopsy, conjunctival swab, and PBMCs (optional, geographic variability) anti-SSA/Ro and anti-SSB/La antibodies (lacrimal gland) |
| Lung | Bronchoscopy and bronchoalveolar lavage Esophagogastroduodenoscopy (optional) |
| Breast | Mammography Breast ultrasonography MRI (or CT scan) of breast |
| Thyroid | Thyroid ultrasonography Thyroid function tests |
| Central nervous system (dura mater) | MRI of brain |
| Skin | Borrelia burgdorferi status (PCR) in the tumor biopsy (optional) |
ENT, ear, nose, and throat; FISH, fluorescence in situ hybridization; IHC, immunohistochemistry; PBMC, peripheral blood mononuclear cells; PS, performance status; SSA, Sjogren's syndrome.