Hüper S, Nagler L, Strunz P P, Froehlich M, Labinsky H, Schmalzing M, Gernert M
Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany.
Praxis für Rheumatologie und Osteologie, Hildesheim, Germany.
Scand J Rheumatol. 2025 Jan;54(1):49-57. doi: 10.1080/03009742.2024.2370109. Epub 2024 Jul 15.
Patients with primary Sjögren's syndrome (pSS) have an increased risk of lymphoma, especially mucosa-associated lymphoid tissue (MALT) lymphoma of the salivary glands. Risk factors for lymphoma are well known, but there are no studies on screening by imaging. Therefore, we aimed to assess the usefulness and adverse effects of ultrasound of the major salivary glands and neck as lymphoma screening.
A retrospective, single-centre, analysis of imaging studies in pSS patients was conducted. Imaging studies were classified as either screening examinations (asymptomatic patients) or occasion-related (imaging due to signs of lymphoma or at least moderate systemic activity). Results were categorized as: not suspicious; requiring control; triggering tissue sampling with exclusion of lymphoma; or triggering tissue sampling with diagnosis of lymphoma.
The study included 134 patients and covered 1031 patient-years. Lymphoma was diagnosed in 15 patients (11.2%), all of whom had clinical signs of lymphoma at the time of diagnosis. During this period, 569 screening examinations and 179 occasion-related examinations were conducted. None of the screening examinations detected lymphoma, but follow-up imaging was recommended in 17.1% (95% CI 14.2-20.4%) and invasive exclusion of lymphoma was performed in 0.5% (95% CI 0.1-1.5%). In contrast, lymphoma was detected in 6.1% (95% CI 3.5-10.6%) of occasion-related examinations.
pSS patients with neither signs of lymphoma nor increased systemic disease activity did not benefit from screening. In contrast, patients with symptoms of lymphoma or at least moderate systemic activity can benefit from imaging of the neck and major salivary glands.
原发性干燥综合征（pSS）患者发生淋巴瘤的风险增加，尤其是唾液腺黏膜相关淋巴组织（MALT）淋巴瘤。淋巴瘤的危险因素已为人熟知，但尚无关于影像学筛查的研究。因此，我们旨在评估主要唾液腺和颈部超声作为淋巴瘤筛查的有效性及不良反应。
对pSS患者的影像学研究进行回顾性单中心分析。影像学研究分为筛查检查（无症状患者）或与特定情况相关的检查（因淋巴瘤体征或至少中度全身活动而行影像学检查）。结果分为：不怀疑；需复查；触发组织取样且排除淋巴瘤；或触发组织取样且诊断为淋巴瘤。
该研究纳入134例患者，涵盖1031患者年。15例患者（11.2%）被诊断为淋巴瘤，所有患者在诊断时均有淋巴瘤的临床体征。在此期间，进行了569次筛查检查和179次与特定情况相关的检查。筛查检查均未检测到淋巴瘤，但17.1%（95%CI 14.2 - 20.4%）的患者被建议进行随访影像学检查，0.5%（95%CI 0.1 - 1.5%）的患者进行了淋巴瘤的侵入性排除检查。相比之下，6.1%（95%CI 3.5 - 10.6%）的与特定情况相关的检查检测到了淋巴瘤。
既无淋巴瘤体征也无全身疾病活动增加迹象的pSS患者无法从筛查中获益。相比之下，有淋巴瘤症状或至少中度全身活动的患者可从颈部和主要唾液腺的影像学检查中获益。
