Background/Purpose: Major salivary gland ultrasonography (SGUS) has an established role as a first-line imaging tool in the diagnosis of primary Sjögren’s syndrome (pSS). Nowadays, however, interest is also arisen in last‐generation ultra high‐resolution ultrasound (UHFUS) transducers, which can produce frequencies up to 70 MHz and achieve tissue resolution up to 30 μm, opening up new possibilities for the study of labial salivary glands (LSG).Purpose: to compare the diagnostic accuracy of LSG-UHFUS with SGUS and to investigate the usefulness of UHFUS in LSG biopsy preoperative planning.

Methods: Consecutive patients undergoing a LSG for clinically suspected pSS were included in this study from January 2018 to March 2020. UHFUS of LSG was performed by using VEVO MD, equipped with a 70 MHz probe, scanning first the central compartment of the inferior lip, and then both peripheral compartments. The following parameters were evaluated: distribution of the glands, parenchymal inhomogeneity (score 0-3, from normal to evident), and fibrosis. UHFUS imaging was used to help locate the LSG for the US-guided biopsy. SGUS findings were defined according to previous studies exploring  both parotid and submandibular glands.

Results: We included a total of 138 patients with suspected pSS: out of them, 61 (44.2%) received a diagnosis of pSS (ACR 2016 criteria) and 77 (55.8%) were diagnosed as no-SS sicca controls. The two groups did not differ in their demographic features, USFR and ESSPRI. With respect to no-SS sicca controls, pSS patients presented both a higher SGUS scores and a higher UHFUS scores in both central and peripheral labial compartments (p< 0.001). UHFUS scores significantly correlated with parotid SGUS scores (r=0.385, p=0.001), submandibular SGUS scores (r=0.463, p=0.001), and with the minor salivary gland focus score (r=0.407, p=0.001); moreover, UHFUS scores were significantly associated with anti-Ro/SSA, anti-La/SSB, RF and hyper-IgG (p< 0.05).  By using a cut-off score≥2, UHFUS sensitivity was slightly higher than SGUS (63.9% vs 60.7%) whereas UHFUS specificity was lower (71.4% vs 79.2%). However, by using a cut-off score< 1, UHFUS sensitivity raised up to 98.4% with a negative predictive value of 93.8%. In our cohort, the sequential combination of the two US techniques (UHFUS followed by SGUS) and the use of different UHFUS cut-off scores would have avoided unnecessary lip biopsy in 46/77 (59.7%) patients with sicca syndrome and no-pSS.

Conclusion: UHFUS of LSG appeared feasible and sensitive in pSS, potentially offering unique advantages in LSG biopsy preoperative planning to avoid unnecessary lip biopsy in patients with sicca symptoms.

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultra-high%e2%80%90resolution-ultrasound-uhfus-of-labial-salivary-glands-might-help-to-avoid-unnecessary-lip-biopsy-in-patients-with-sicca-syndrome/