PT  - JOURNAL ARTICLE
AU  - Johannes Duell
AU  - Franziska Krummenast
AU  - Andreas Schirbel
AU  - Philipp Klassen
AU  - Samuel Samnick
AU  - Hilka Rauert-Wunderlich
AU  - Leo Rasche
AU  - Andreas K. Buck
AU  - Hans-Jürgen Wester
AU  - Andreas Rosenwald
AU  - Hermann Einsele
AU  - Max S Topp
AU  - Constantin Lapa
AU  - Malte Kircher
TI  - Improved primary staging of marginal zone lymphoma by addition of CXCR4-directed PET/CT
AID  - 10.2967/jnumed.120.257279
DP  - 2021 Feb 01
TA  - Journal of Nuclear Medicine
PG  - jnumed.120.257279
4099  - http://jnm.snmjournals.org/content/early/2021/02/12/jnumed.120.257279.short
4100  - http://jnm.snmjournals.org/content/early/2021/02/12/jnumed.120.257279.full
AB  - Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodesoxyglucose (FDG) is an integral component in the primary staging of most lymphomas. However, its utility is limited in marginal zone lymphoma (MZL) due to inconsistent FDG avidity. One diagnostic alternative could be the targeting of CXC-motif chemokine receptor 4 (CXCR4), shown to be expressed by MZL cells. This study investigated the value of adding CXCR4-directed 68Ga-Pentixafor PET/CT to conventional staging. Methods: 22 newly diagnosed MZL patients were staged conventionally and with 68Ga-Pentixafor PET/CT. Lesions exclusively identified by 68Ga-Pentixafor PET/CT were biopsied as standard of reference and compared to imaging results. The impact of CXCR4-directed imaging on staging results and treatment protocol was assessed. Results: 68Ga-Pentixafor PET/CT correctly identified all patients with viable MZL and was superior to conventional staging (P < 0.001). CXCR4-directed imaging results were validated by confirmation of MZL in 21/24 PET-guided biopsy samples. Inclusion of 68Ga-Pentixafor PET/CT in primary staging significantly impacted staging results in almost half, and treatment protocols in one third of patients (upstaging, n = 7; downstaging, n = 3; treatment change, n = 8; P < 0.03). Conclusion: 68Ga-Pentixafor PET/CT is a suitable tool in primary staging of MZL and holds the potential to improve existing diagnostic algorithms.