Safety, patient acceptance and diagnostic accuracy of ultrasound core needle biopsy of parotid or submandibular glands in primary Sjögren’s syndrome with suspected salivary gland lymphoma

Abstract

BackgroundEnlargement of the major salivary glands (SGs) is a major risk factor for B-cell lymphoma among patients with primary Sjögren’s syndrome (pSS). Ultrasound-guided core needle biopsy (US-guided CNB) could be a novel technique to manage SG enlargement among patients with pSS.ObjectiveAccordingly, this study’s main aim was to evaluate the safety, patient tolerance and diagnostic accuracy of US-guided CNB procedure for patients with pSS with major SG enlargement.MethodsPatients with clinical diagnosis of pSS and a clinical indication for SG biopsy consecutively underwent US-guided CNB between September 2019 and June 2021. These patients were evaluated clinically 1, 2 and 12 weeks after US-guided CNB. Patients were asked to complete a questionnaire about postprocedural complications as well as periprocedural pain, using the Visual Analogue Scale. Complications were categorised as transient (<12 weeks) or persistent (≥12 weeks).ResultsUS-guided CNB was performed on 30 major salivary glands (22 parotid glands and 8 submandibular glands). The procedure was well tolerated. Transient complications—such as haematoma, swelling—were observed among 43% of patients, and mean periprocedural pain was low. However, no persistent complications were reported during the study’s follow-up period.ConclusionUS-guided CNB represents a novel approach for the management of patients with pSS with SG enlargement. The procedure showed remarkable patient safety and tolerance, allowing adequate glandular sampling and a definite diagnosis for almost all participating patients without long-term complications.

Salivary Gland Ultrasound in Primary Sjögren’s Syndrome: Current and Future Perspectives

“… 94 Despite the theoretical risk of facial nerve injury and other complications, when properly performed, a CNB of major SGs may determine transient adverse reactions, with no permanent complications. 19 , 94 , 95 Therefore, US-guided CNB of the SGs can be considered a safe, feasible, and accurate technique in patients with pSS.

Figure 10 Several approaches to US-guided CNB of the parotid and submandibular glands.

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The importance of studying the parotid glands in primary Sjögren's syndrome: the right tissue at the right time

“…Recently, we proposed the use of ultrasound-guided CNB (US-guided CNB) of the parotid gland for the diagnosis of glandular lymphoma in this subset of pSS with PSW. We demonstrated that US-guided CNB can provide adequate sampling for histological examination, immunohistochemical staining and flow cytometry (16,18). In the case of PSW, this procedure can be safely performed in the posterocaudal part of the gland, in a safe zone where facial nerve injuries are avoided.…”

“…In the case of PSW, this procedure can be safely performed in the posterocaudal part of the gland, in a safe zone where facial nerve injuries are avoided. Additional investigation with promising results on the accuracy and safety of US-guided CNB, parotid or submandibular, and in the parotid "safe zone", i.e., also independently from the presence of PSW, are now completed by our group (16,18). The correct disease diagnosis, the relevance and the choice of SGUS glandular areas in disease follow-up, and the analysis in detail of SGUS focal and diffuse areas, with particular reference to lymphoma and its risk, have been planned in larger and multicentric cohorts.…”

“…Improvements in SGUS and parotid biopsy, either surgical (52) or SGUS-targeted with core needle biopsy (CNB) (16,18), are the most compelling developments supporting a more intensive investigation of the parotid glands in pSS. The importance of SGUS and its main alteration in pSS, parenchymal inhomogeneity by ultrasound, was asserted 30 years ago (8); however, scarce attention was given for a long time to this diagnostic tool, which is still not included in pSS classification criteria and is still the object of reliability and accuracy studies (53).…”

“…First, in pSS, the parotid is a target tissue where autoimmune-related lymphoid expansion results in mucosaassociated lymphoid tissue (MALT) acquisition (1)(2)(3)(4) and is a major predictor of non-Hodgkin lymphoma (NHL) (5)(6)(7). Second, assessment of the parotids is now much more feasible, either indirectly by salivary gland ultrasonography (SGUS) (8)(9)(10)(11)(12)(13) or directly by tissue biopsy (14)(15)(16)(17)(18)(19). Both of these tools are likely to be more widely used in the years ahead.…”