Johns Hopkins University School of Medicine, Baltimore, Maryland.
Arthritis Care Res (Hoboken). 2021 Jun;73(6):849-855. doi: 10.1002/acr.24203.
To evaluate the safety and utility of core needle biopsy (CNB) for diagnosis of salivary gland lymphoma in Sjögren's syndrome (SS).
We analyzed data from consecutive SS patients who underwent ultrasound-guided major salivary gland CNB for lymphoma diagnosis and determined whether CNB yielded an actionable diagnosis without need for further intervention.
CNBs were performed in 24 patients to evaluate discrete parotid (n = 6) or submandibular (n = 2) gland masses or diffuse enlargement (n = 16; 15 parotid). One patient had 3 CNBs of the same mass. Of the 26 CNBs, 24 included flow cytometry, using CNB and/or fine needle aspirate material, and 14 targeted sonographically identified focal lesions. No patient reported complications. In the 23 patients with 1 CNB, final diagnoses were marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT; n = 6), atypical lymphoid infiltration (n = 3), benign lymphoepithelial sialadenitis (n = 9), normal gland tissue (n = 4), and lymphoepithelial cyst (n = 1). In the patient with serial CNBs, the initial one without flow cytometry was benign, but the next 2 showed atypical lymphoid infiltration. Monoclonal lymphoid infiltration was detected in 12 patients: 6 with MALT lymphoma, 3 were benign, and 3 with atypical lymphoid infiltration. Of the latter 3, 1 was treated with rituximab and 2 with expectant observation. The diagnosis changed from atypical lymphoid infiltration to MALT lymphoma in 1 patient following biopsy of inguinal adenopathy 6 months post-CNB. CNB provided actionable results and avoided open excisional biopsies in all cases.
CNB is safe and useful in the evaluation of suspected salivary gland lymphoma in SS.
评估在干燥综合征（SS）患者中，使用核心针活检（CNB）对唾液腺淋巴瘤进行诊断的安全性和实用性。
我们分析了连续接受超声引导下大唾液腺 CNB 以诊断淋巴瘤的 SS 患者的数据，并确定 CNB 是否提供了无需进一步干预即可采取行动的诊断结果。
为了评估离散的腮腺（n = 6）或下颌下腺（n = 2）肿块或弥漫性肿大（n = 16；15 个腮腺），对 24 例患者进行了 CNB。1 例患者的同一体积进行了 3 次 CNB。在 26 次 CNB 中，24 次包括使用 CNB 和/或细针抽吸物进行流式细胞术，14 次针对超声识别的局灶性病变。没有患者报告并发症。在 23 例接受 1 次 CNB 的患者中，最终诊断为黏膜相关淋巴组织（MALT）的边缘区淋巴瘤（n = 6）、非典型淋巴样浸润（n = 3）、良性淋巴上皮涎腺炎（n = 9）、正常腺组织（n = 4）和淋巴上皮囊肿（n = 1）。在进行系列 CNB 的患者中，最初一次未进行流式细胞术的结果为良性，但随后的 2 次显示非典型淋巴样浸润。12 例患者检测到单克隆淋巴样浸润：6 例 MALT 淋巴瘤，3 例为良性，3 例为非典型淋巴样浸润。在这 3 例中，1 例接受利妥昔单抗治疗，2 例接受观察等待。在 CNB 后 6 个月活检腹股沟淋巴结时，1 例患者的诊断从非典型淋巴样浸润转变为 MALT 淋巴瘤。在所有情况下，CNB 均提供了可采取行动的结果并避免了开放性切除活检。
在 SS 患者中，CNB 是安全且有用的，可用于评估疑似唾液腺淋巴瘤。
