Ultrasound-guided core needle biopsy compared with open biopsy: a new diagnostic approach to salivary gland enlargement in Sjögren’s syndrome?

Abstract

Objective Persistent (≥2 months) major salivary gland enlargement in primary SS (pSS) patients is a well-known sign of possible involvement by B cell lymphoma. The study aimed to evaluate the diagnostic accuracy and safety of US-guided core needle biopsy (CNB) of major salivary glands compared with open surgical biopsy. Methods Prospective pSS patients (cases) with clinically persistent salivary gland enlargement underwent US-guided CNB and were compared with retrospective pSS patients (controls) submitted to open surgical biopsy. The features analysed were pre-biopsy clinical and laboratory findings, adequacy of the material for histology and diagnostic-rendered and biopsy-related complications (reported by the patient with a questionnaire and clinically verified). Results Thirteen cases underwent US-guided CNB: in nine, biopsy was performed on the parotid gland and in four it was performed on the submandibular gland. Sufficient material was obtained for pathological diagnosis in all samples. The final diagnoses were 5 (38.5%) B cell lymphoma, 1 (7.7%) lymphoepithelial sialadenitis, 4 (30.7%) other sialadenitis (granulomatous consistent with sarcoidosis, IgG4-related disease, chronic sclerosing, diffuse chronic) and 3/13 (23.1%) miscellaneous lesions. Thirteen controls underwent open surgical biopsy of the parotid. In one, inadequate material was obtained, while in 12 (92.3%) the pathologic diagnoses were 4 (33.3%) B cell lymphoma, 2 (16.7%) lymphoepithelial sialadenitis, 4 (33.3%) uncertain lymphoproliferative lesions and 2 (16.7%) miscellaneous lesions. Six cases (46.1%) reported six transient complications and 12/13 (92.3%) controls had 2 persistent and 14 transient complications. Conclusion US-guided CNB represents a novel, clinically relevant and safe approach for the management of pSS patients with parotid or submandibular persistent enlargement.

Normal-Appearing Salivary Gland Ultrasonography Identifies a Milder Phenotype of Primary Sjögren's Syndrome

“…Improving the identification of a milder disease subset is an unmet need in pSS (41), and therefore, the SGUS could be of major value to this end. Moreover, the SGUS may be employed to detect and to guide diagnostic biopsy of salivary gland lymphoma (42,43), which is one of the main causes of increased mortality in pSS (36), and to follow-up pSS patients with parotid swelling, i.e., a major risk factor or an early manifestation of lymphoma itself (44).…”

Ultrasound and Bioptic Investigation of Patients with Primary Sjögren’s Syndrome

“…Lymphoma detection by SGUS in pSS has been described in some case series: they individuate, as expected, mostly MALT lymphoma (with two typical patterns described: the "linear echogenic strands pattern" also referred to as "multiple small hypoechoic nodules" or "tortoiseshell pattern", and the "segmental pattern"/"multiple layer hypoechoic masses") although no generally defined sonographic criteria for parotid lymphomas exist, as they present various non-specific US appearances [10,[44][45][46]; see Figure 1. However, in a recently published series, MALT lymphoma detected by SGUS also appeared as focal, hypoechoic, and dishomogeneous, with hypervascular areas with posterior acoustic enhancement, variable morphology and margins, and internal septa in half However, in a recently published series, MALT lymphoma detected by SGUS also appeared as focal, hypoechoic, and dishomogeneous, with hypervascular areas with posterior acoustic enhancement, variable morphology and margins, and internal septa in half of the cases [47]. Importantly, only specific areas, and not all of the parotid gland, appeared to be involved by SGUS, which led to a new application of SGUS in pSS: to guide major SGs biopsy in definite glandular areas, usually in pSS patients with persistent parotid or submandibular enlargement.…”

Needle Biopsy Compared With Surgical Biopsy: Pitfalls of Small Biopsy in Histologial Diagnosis of IgG4-related Disease

“…Besides, plasma cells crushed by an artifact tend to cause unsuccessful immunostaining in smaller samples [15] . The quality of a needle biopsy might also depend on the experience of the operator, the number of cores obtained from the lesion, the gauge of the needle we used and the ultrasound direction [16] .…”

“…Regions with restricted lesions may not represent the full features of the disorder. In contrast, ultrasound-guided needle biopsy is able to distinguish areas with different sonographic patterns and target the most suspicious lesions [16] . In addition, whenever any kind of neoplasm is possible, open biopsy is contraindicated since it may compromise patients' outcome (e.g.…”