Screening and Diagnosis of Lymphoma in Mixed Connective Tissue Disease

Screening Recommendations

• The American Thoracic Society recommends that all patients with MCTD should undergo screening with high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) including spirometry and diffusing capacity for carbon monoxide (DLCO) at diagnosis 1
• For MCTD patients with systemic sclerosis phenotype, reassessment should include PFTs every 6 months and HRCT every year for the first 3-4 years after diagnosis, as suggested by the Pulmonology society 1
• The European League Against Rheumatism recommends screening for malignancy if the patient has rapidly progressive disease, weight loss, advanced age, or other features suggesting paraneoplastic syndrome 2

Diagnostic Approach for Suspected Lymphoma in MCTD Patients

• The National Comprehensive Cancer Network recommends that initial workup for suspected lymphoma should include thorough physical examination with attention to node-bearing areas, evaluation of performance status, and assessment of constitutional symptoms 3
• Laboratory assessments should include complete blood count with differential, comprehensive metabolic panel, and measurements of serum lactate dehydrogenase (LDH), as recommended by the National Comprehensive Cancer Network 3
• The National Comprehensive Cancer Network suggests that bone marrow evaluation is essential as lymphomas, particularly mantle cell lymphoma, frequently involve the bone marrow 3