Session Title: Sjogren's Syndrome: Clinical Science
Session Type: Abstract Submissions (ACR)
Ultrasound-guided core needle biopsy (CNB) has greater inherent risks than fine-needle aspiration for the diagnosis of major salivary gland neoplasms, but provides tissue for histologic analysis. We sought to evaluate the safety and utility of CNB in the evaluation of salivary gland abnormalities in patients with suspected or established Sjögren’s syndrome (SS).
We identified 19 patients who underwent ultrasound-guided CNB of either the parotid or submandibular gland as part of a diagnostic evaluation in our SS Center between 7/2009-5/2014. CNBs of the parotids were obtained using a posterior-inferior approach from the tail of the superficial lobe to avoid injury to the facial nerve. Patients were contacted one day after the procedure to assess for complications. The patient charts were reviewed retrospectively, using a protocol approved by the institutional review board.
The 5 men and 14 women had a median age of 55 years (range, 19-74). Seven patients had an established SS diagnosis and underwent the procedure to exclude lymphoma as the cause for symmetric or asymmetric salivary gland enlargement. The remaining 12 with suspected SS underwent the procedure because of bilateral salivary gland enlargement and/or induration (n=11) or an elevated serum IgG4 level (n=1), but only one was diagnosed with SS. The 19 procedures involved sampling of parotid (n=14) or submandibular (n=5) gland parenchyma and constituted CNB alone (n=9) and CNB with FNA (n=10); flow cytometry was performed on 7/10 FNA samples. None of the patients reported complications one day post-procedure or during longitudinal follow-up [median (range) duration=172 days (1-924)]. Among the established SS patients, 3/6 had a clonal B-cell population on FNA flow cytometry, but lymphoma was only diagnosed in 1 based on CNB histology. The remaining 2 patients with abnormal FNA flow cytometry had CNB histology of benign lymphoepithelial sialadenitis and did not develop signs of lymphoma during follow-up of 2.3-2.5 years. One patient with established SS underwent CNB alone and the histology showed no lymphoid aggregates. Among the 12 patients with suspected SS, final pathologic diagnoses from CNB included: eosinophilic sialadenitis (n=2), normal parotid gland tissue with/without fatty infiltration (n=8), chronic sialadenitis not related to SS (n=1), and extensive fibrosis (n=1). The utility of CNB as a diagnostic tool for salivary gland disease was supported by its identification of: 1) pathologic abnormalities (lymphoid infiltrates or >50% fibrosis) in 10/10 patients with abnormal salivary gland ultrasound echotexture and 2) lymphoid infiltrates in 5/8 patients with established SS. Three patients with enlarged parotid glands but normal ultrasound echotexture had a CNB showing fatty infiltration with normal acinar tissue.
Ultrasound-guided CNB of the major salivary glands can be done safely and provides useful diagnostic information about salivary gland abnormalities in the evaluation and management of SS. The evaluation of possible lymphoma should include both CNB and FNA with flow cytometric analysis of the sample since the finding of a clonal B-cell population is not sufficient to make a diagnosis of lymphoma.
Q. K. Li,
A. N. Baer,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasound-guided-core-needle-biopsy-of-the-major-salivary-glands-is-a-safe-and-useful-diagnostic-tool-in-the-evaluation-of-suspected-or-established-sjogrens-syndrome/