Ultra High‐frequency Ultrasound (UHFUS) of Labial Glands in Primary Sjögren’s Syndrome: Serological and Histological Correlations

Giovanni Fulvio¹, Francesco Ferro¹, Rossana Izzetti², Gianmaria Governato¹, Silvia Fonzetti¹, Gaetano La Rocca¹, Valentina Donati³, Davide Caramella⁴, Marta Mosca⁵ and Chiara Baldini⁶, ¹University of Pisa, Rheumatology Unit, Pisa, Italy, ²University of Pisa, Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Pisa, Italy, ³AOUP, Unit of Pathological Anatomy, Pisa, Italy, ⁴University of Pisa, 3Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, Pisa, Italy, ⁵Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy, ⁶University of Pisa, Pisa, Italy

Meeting: ACR Convergence 2021

Keywords: Sjögren's syndrome, Ultrasound

Session Information

Date: Saturday, November 6, 2021

Session Title: Sjögren's Syndrome – Basic & Clinical Science Poster (0296–0322)

Session Type: Poster Session A

Session Time: 8:30AM-10:30AM

Background/Purpose: Last‐generation ultra high‐frequency ultrasound (UHFUS) transducers are highly sensitive tools potentially able to open new avenues for the identification of imaging biomarkers. Recently UHFUS has been applied to the study of labial salivary glands (LSG) in patients with suspected primary Sjögren’s syndrome (pSS) showing a good diagnostic accuracy in identifying pSS from no-SS sicca. Objective:1. to assess the association between UHFUS scoring and LSG histology in patients with established pSS; 2. to explore the association between LSG-UHFUS scoring and anti-Ro antibody specificity (i.e. both anti-Ro60 and Ro52 or isolated anti-Ro52 and anti-Ro60 antibodies).

Methods: Out of a cohort of 207 patients who underwent a UHFUS guided LSG biopsy for suspected pSS (Jan 2018-Apr 2021), we identified 92 patients with an established newly diagnosed pSS (ACR/EULAR 2016 criteria). Patients’ clinical, biological and histological features were collected. The anti-Ro antibody specificity and titer were determined by immunoblotting. UHFUS of LSG was performed by using VEVO MD, equipped with a 70 MHz probe, evaluating parenchymal inhomogeneity (score 0-3). For each of the LSG specimens number of foci, focus score (FS) and ectopic lymphoid structures (ELS) were assessed.

Results: We included a total of 92 pSS patients: 41 (44.6%) with anti-Ro60 and anti-Ro52, 6 (6.5%) with anti-Ro60 alone, 25 (27.2%) with anti-Ro52 alone, and 20 (21.7%) with neither antibody. A UHFUS score 1 was observed in 32 (34.8%), a UHFUS score 2 in 47 (51.1%) and a UHFUS score 3 in 13 (14.1%) pSS patients. The UHFUS scoring was equally distributed within the four serotype subgroups; however, we observed a moderate correlation (r=0.300, p=0.01) between the UHFUS scoring and the anti-Ro60 titer. UHFUS score correlated also with IgG levels and with parotid and submandibular US (p< 0.05). No correlation was observed between UHFUS and ESSPRI, salivary flow and ocular tests. Regarding LSG histology, the higher was the UHFUS grading, the higher were: the number of foci (foci, mean (S.D) : 2.6 (2.8) in UHFUS-score 1 vs 5.9 (3.3) in UHFUS-score 3, p=0.001), the FS (FS, mean (S.D): 1.3 (1.2) in UHFUS-score 1 vs 2.1 (0.9) in UHFUS-score 3, p=0.01) and the number of ELS (ELS, mean (S.D): 0.9 (1.1) in UHFUS-score 1 vs 2.5 (1.9) in UHFUS-score 3, p=0.01). Noteworthy, out of the 13 patients with a UHFUS-score 3, 12/13 presented at least one ELS in their biopsies (p=0.01). UHFUS score-3 showed a specificity of 97.1% and a positive predictive value of 92.3% in the evaluation of ELS in LSGs.

Conclusion: UHFUS of LSG appeared significantly associated with serological and histological findings in pSS and may have a role in patients’ stratification.

Disclosures: G. Fulvio, None; F. Ferro, None; R. Izzetti, None; G. Governato, None; S. Fonzetti, None; G. La Rocca, None; V. Donati, None; D. Caramella, None; M. Mosca, None; C. Baldini, None.

To cite this abstract in AMA style:

Fulvio G, Ferro F, Izzetti R, Governato G, Fonzetti S, La Rocca G, Donati V, Caramella D, Mosca M, Baldini C. Ultra High‐frequency Ultrasound (UHFUS) of Labial Glands in Primary Sjögren’s Syndrome: Serological and Histological Correlations [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/ultra-high%e2%80%90frequency-ultrasound-uhfus-of-labial-glands-in-primary-sjogrens-syndrome-serological-and-histological-correlations/. Accessed February 3, 2023.

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