Background/Purpose: Salivary gland ultrasonography has been proposed as a promising novel tool for the diagnosis of primary Sjögren’s syndrome (SS).  An increasing number of studies have shown strong correlations between parenchymal inhomogeneity and disease histological and serological features.  However, the correlation between abnormal findings at the salivary gland ultrasonography and traditional risk factors for lymphoma development has not been explored, yet. Aim of this study was to evaluate whether potential abnormalities at the salivary gland ultrasonography might be correlated to any of the traditional histological and serological risk factors for lymphoma development in order to assess the role of salivary gland ultrasonography in the prognostic stratification of primary SS patients.

Methods: Patients with SS (AECG 2002) and different disease duration were consecutively enrolled in this study and systematically evaluated for traditional risk factors for lymphoma (current or past history). Salivary gland ultrasonography was performed by using a Logic 9 system. A simplified scoring system based on parenchymal inhomogeneity (ranging from grade 0 to grade 4) was adopted to assess major salivary gland involvement on the ultrasound. A grade ≥2 was considered as pathological.

Results: We included in the study 127 patients with SS (mean age = 57±5 yrs; disease duration= 14±7 yrs). The mean ultrasonographic score of the overall population was 2.5±2.3 (range 0-8). Seventy-nine patients (62.2%) presented a moderate to severe parenchymal inhomogeneity (i.e ultrasonographic score ≥2). A significantly higher mean ultrasonographic score was detected in patients with history of purpura (4.5±2.7 vs 2.4±2.3, p=0.01), salivary gland enlargement (4.3±1.9 vs 1.8±2.0, p<0.001), positivity for cryoglobulins (5.52±1.8 vs 2.4±2.3, p=0.008), and presence of  germinal center in the minor salivary gland biopsy (3.9±2.3 vs 1.6±2.1, p<0.001).The overall ultrasonographic score directly correlated with the IgG levels (r=0.384, p=0.000) and inversely with both C4 levels (r= -0.207, p=0.000) and lymphocytes count (r=-232, p=0.01). 

Conclusion: This study suggested that salivary gland ultrasonography may represent a non invasive additional tool to be used in clinical practice for the prognostic stratification of patients with SS and, specifically to distinguish those patients at higher risk for lymphoma development.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/salivary-gland-ultrasonography-as-an-useful-tool-to-distinguish-patients-with-sjogrens-syndrome-at-risk-for-non-hodgkins-lymphoma-development/