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. 2021 Jun;73(6):849-855.
doi: 10.1002/acr.24203.

Ultrasound-Guided Biopsy of Suspected Salivary Gland Lymphoma in Sjögren's Syndrome

Alan N Baer  1 , Thomas Grader-Beck  1 , Brendan Antiochos  1 , Julius Birnbaum  1 , Joel M Fradin  1
Affiliations

Ultrasound-Guided Biopsy of Suspected Salivary Gland Lymphoma in Sjögren's Syndrome

Alan N Baer et al. Arthritis Care Res (Hoboken). 2021 Jun.

Abstract

Objective: To evaluate the safety and utility of core needle biopsy (CNB) for diagnosis of salivary gland lymphoma in Sjögren's syndrome (SS).

Methods: 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.

Results: 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.

Conclusion: CNB is safe and useful in the evaluation of suspected salivary gland lymphoma in SS.

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Conflict of interest statement

None of the authors report financial support or other benefits from commercial sources for the work reported on in the manuscript, or any other financial interests, which could create a potential conflict of interest or the appearance of a conflict of interest with regard to the work.

Figures

Figure 1:
Figure 1:
Parotid gland core needle biopsy with ultrasound guidance. A, The biopsy needle is directed from posterior to anterior, with care taken to keep the needle path located superficially within the gland parenchyma and the entire trough of the needle within parenchyma; B, Patient is in right side down decubitus position with head on the right side of the photograph as biopsy needle approaches left parotid gland from its posterior aspect. The biopsy is guided by real-time ultrasound, under aseptic conditions; C, Both the operator and the assisting sonographer monitor the path of the needle on the ultrasound screen.
Figure 2:
Figure 2:
Ultrasound images of lymphomatous lesions of the parotid gland. A, An abnormal intraparotid lymph node is evident in this longitudinal view (patient #18). The node was considered abnormal because of its enlargement and rounded shape; B, A blood vessel is seen on color Doppler imaging penetrating the hilum of the intraparotid node seen in panel A; C, A heterogeneously hypoechoic, mixed solid and cystic mass is evident in this longitudinal view (patient #22).
See this image and copyright information in PMC

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