Comparison of Ultrasound Features of Major Salivary Glands in Sarcoidosis, Amyloidosis, and Sjögren's Syndrome

Abstract

Objective While salivary gland ultrasound (SGU) has gained prominence for evaluating Sjögren's syndrome, little information exists on SGU appearance of sarcoidosis and amyloidosis, potential mimics of Sjögren's syndrome. Our goal in this study was to estimate the diagnostic accuracy of major SGU features in differentiating Sjögren's syndrome from sarcoidosis, amyloidosis, and controls. Methods We enrolled consecutive adult ambulatory patients with a clinical diagnosis of Sjögren's syndrome fulfilling the 2016 American College of Rheumatology (ACR) classification criteria; we also enrolled patients with a clinical diagnosis of sarcoidosis or systemic immunoglobulin light chain (AL) amyloidosis, with histologic confirmation from any tissue, and rheumatology outpatients without diagnoses affecting salivary glands. Subjects underwent major SGU using the Hočevar protocol, with resulting video clips reviewed blind to clinical diagnosis. Results Sjögren's syndrome SGU scores were greater than in patients from the other groups, but there were no distinguishing salivary gland features from AL amyloidosis or sarcoidosis. None of the patients in the control group scored higher than 17, a cutoff previously suggested for Sjögren's syndrome, but 27% of patients with AL amyloidosis and 19% with sarcoidosis scored higher than 17. Adding Hočevar SGU scores of ≥17 to the 2016 ACR/European League Against Rheumatism criteria in a parallel scheme increased the sensitivity for Sjögren's syndrome from 87% to 98%, while combining the 2 criteria in series increased specificity from 81% to 98%. Conclusion Sjögren's syndrome, sarcoidosis, and AL amyloidosis share common SGU features that can help distinguish these conditions from patients without systemic rheumatologic disease. Clinicians should carefully consider these potential mimics when interpreting salivary gland US results.

Shear Wave Elastography of Salivary and Thyroid Glands in Pediatric Patients With FMF and Amyloidosis

“…Parenchymal heterogeneity, enlargement of the gland and changes in the vascularity as well as the fibrotic bands and mass lesions could be clearly represented with ultrasonography. The ultrasound features of Sjögren's syndrome in major the salivary gland have been described as hypoechoic lesions with hyperechoic septations in enlarged salivary glands (6). However, the ultrasonographically detectable appearance may be because of chronic parotitis due to Sjögren's syndrome.…”

“…There have been limited findings about the appearance of amyloidosis on ultrasonography. A recent study revealed that heterogeneity and hypoechoic area score have been found to be higher in light chain amyloidosis compared to control subjects (6). Further assessment of tissue amyloidosis can be performed with histopathological analysis using Congo red staining.…”

Ultrasonographic Subclinical Signs of Inflammation of the Lacrimal, Parotid, and Submandibular Glands in Users of Cosmetic Fillers

“…The ultrasound examination of the glands was focused on detecting abnormalities of the parenchyma and hypervascularity signs that were suggestive of inflammation, according to the literature 11,14–16,29–31 . The glands' echostructure and vascularity were compared with a control group conformed by 10 female patients without exposure to fillers and derived to the ultrasound examination because of noninflammatory dermatologic focal lesions located in the trunk or extremities (age: 34–57 years; mean age: 48 years).…”

“…The facial glands' inflammation can generate dry eyes (xerophthalmia) or dry mouth (xerostomia), presenting potential complications 10,11 . Moreover, none of these symptoms are investigated in the routine clinical evaluation of CFs' users.…”

Histopathology in primary Sjögren's syndrome: Diagnosis, clinical trials and new insights

“…The SGUS is currently not specific enough to differentiate salivary gland changes 197 9 related to pSS from changes occurring in other auto-immune diseases such as sarcoidosis, amyloidosis and IgG4 related disease. 123,124 Furthermore, the diagnosis of a (developing) salivary gland MALT-lymphoma cannot be made based upon SGUS.…”