POS0795 ULTRASOUND-GUIDED CORE NEEDLE BIOPSY: AN EFFECTIVE AND SAFE TOOL TO DIAGNOSE SJÖGREN`S SYNDROME AND LYMPHOMA OF THE MAJOR SALIVARY GLANDS

Background:Histopathology is a cornerstone of diagnostics in Sjögren`s syndrome (SjS). The current widely accepted standard, minor salivary gland (lip) biopsy, is a surgical procedure with several disadvantages including permanent sensory loss of the lips as a well-known complication (reviewed in 1). Moreover, lymphoma of salivary glands cannot be excluded. Ultrasound-guided core needle biopsy (CNB) is an excellent diagnostic tool with good safety (2) and encouraging results as compared to open biopsy (3).Objectives:To retrospectively analyze safety and diagnostic outcome of ultrasound-guided CNB in patients with known or suspected SjS.Methods:A retrospective analysis of a case series of four patients with known or suspected SjS. All patients were treated at the outpatient clinic of the Department of Rheumatology & Immunology, and the Department of Otorhinolaryngology. All patients underwent ultrasound-guided CNB: We clean and disinfect the ultrasound transducer and the skin of the patient before and after the procedure. We use a sterile probe cover and gloves. Only sterile ultrasound gel or ultrasound compatible disinfectant should be used. Core-needle biopsy was performed using a 20 g needle (Bard). A Logiq S8 GE ultrasound device with a 6-15 MHz matrix linear transducer was used. We performed a local anesthesia at the entry point and a 2mm skin incision. The sampling length was set on 20mm. The CNB was performed at the most suspicious focal sonographic lesion. 2-3 needle passes were carried out through the same skin access.Results:Representative histopathological samples were obtained from all patients. In patient 1 (62y) with known SjS and parotid swelling, mucosa-associated lymphoid tissue (MALT) lymphoma was diagnosed (previous lip biopsy with no proof of malignancy). Also in patient 2 (35y) with known SjS and a 20-years history of parotid swelling, MALT lymphoma was diagnosed. In this patient a lip biopsy was performed in the previous year supporting the diagnosis of SjS, but without proof of malignancy. In patient 3 (64y) with SSc, anti-Ro/SSA positivity and dry eyes and mouth, the biopsy established the diagnosis of SjS. In patient 4 (59y) with SSc, negative anti-Ro/SSA antibodies and dry eyes/mouths, SjS could be excluded. In the corresponding ultrasound, all patients showed hypoechogenic lesions and inhomogeneous parenchyma of major salivary glands reflecting OMERACT grade II-III SjS ultrasound score (4). No safety signals were observed. Patients with prior lip biopsies perceived ultrasound-guided CNB as preferable.Conclusion:This pilot study suggests that ultrasound-guided CNB in SjS is a safe procedure with an excellent diagnostic yield allowing the diagnosis of lymphoma of the salivary glands, which is superior to lip biopsy. Given these encouraging results, we will now increase patient numbers for further validation.References:[1]Pijpe, J., et al., Parotid gland biopsy compared with labial biopsy in the diagnosis of patients with primary Sjogren’s syndrome. Rheumatology (Oxford), 2007. 46(2): p. 335-41.[2]Kim, H.J. et al., Ultrasound-guided core needle biopsy in salivary glands: A meta-analysis. Laryngoscope, 2018. 128(1): p. 118-125.[3]Zabotti, A. et al., Ultrasound-guided core needle biopsy compared with open biopsy: a new diagnostic approach to salivary gland enlargement in Sjögren’s syndrome? Rheumatology (Oxford). 2020.17:keaa441. Epub ahead of print.[4]Jousse-Joulin, S., et al., Video clip assessment of a salivary gland ultrasound scoring system in Sjogren’s syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise. Ann Rheum Dis, 2019. 78(7): p. 967-973.Disclosure of Interests:Urs Borner: None declared, Lluis Nisa Hernandez: None declared, Adela-Cristina Sarbu: None declared, Lisa Christ Shareholder of: Roche, Grant/research support from: Gilead, Roche, Pfizer, Yara Banz: None declared, Britta Maurer Speakers bureau: Boehringer-Ingelheim, Grant/research support from: Abbvie, Protagen, Novartis Biomedical Research and congress support from Pfizer, Roche, Actelion, mepha, and MSD. BM has a patent for mir-29 for the treatment of systemic sclerosis issued (US8247389, EP233143)., Marco D. Caversaccio Grant/research support from: Medel, Cochlear, Oticon, Storz, Florian Kollert Shareholder of: Roche, Consultant of: Actelion, BMS, Boehringer-Ingelheim, Pfizer, Grant/research support from: Gilead, Pfizer, Employee of: In the past at Novartis, currently at Roche

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POS0735 ULTRASOUND-GUIDED CORE NEEDLE BIOPSY FOR SALIVARY GLAND ENLARGEMENT IN SJÖGREN’S SYNDROME: PROCEDURE SAFETY AND PATIENT TOLERANCE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1804 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 618-619

Author(s):

A. Zabotti ◽

I. Giovannini ◽

S. Z. Callegher ◽

V. Manfrè ◽

M. Lorenzon ◽

...

Keyword(s):

Sjögren’S Syndrome ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Ultrasound Guided ◽

Research Support ◽

Core Needle ◽

Sjögren‘S Syndrome

Background:Persistent enlargement of major salivary glands (SGs) is one of the main risk factors for B-cell lymphoma in primary Sjögren’s syndrome (pSS). The Ultrasound-guided Core Needle Biopsy (US-guided CNB) could be a novel technique for the management of SGs enlargement in pSS (1).Objectives:To evaluate the procedure safety and the patient tolerance of US-guided CNB in pSS patients with major SGs enlargement.Methods:Consecutive patients, with either definite or clinically suspected pSS, and with clinical indication for SGs biopsy due to persistent glandular enlargement were screened for US-guided CNB from September 2019 to December 2020. All patients were evaluated clinically between 1 and 2 weeks and 12 weeks following US-guided CNB. All patients were asked to complete a questionnaire to report post-procedural complications (Figure 1, English version) and intra- and post-procedural pain Visual Analogue Scale (VAS). The complications were classified as transient (<12 weeks) or persistent (≥12 weeks).Results:US-guided CNB was performed in 21 glands (12 parotid and 9 submandibular glands) in 20 pSS patients. 16/20 (80%) patients fulfilled the ACR-EULAR classification criteria for pSS (2). The mean age at the time of biopsy was 62.1 (±11.7) years. US-guided CNB was well tolerated, no long-term complications were reported in the follow-up period (mean 9.5 ±5.7 months). Only transient complications were noticed in 11 patients (55%). In particular, two cases of local swelling at the biopsy site lasting no more than 6 days, one case of local bleeding and subsequently hematoma of the submandibular area, one case of transient facial paresis (lasting less than one hour), seven cases of post-procedural mild local pain, that resolved within 10 days without the need of analgesics (Table 1). The procedure was well tolerated, with a very low reported intra-operative pain (mean VAS 1.74 ±2.49) and a mean post-operative pain VAS of 1.39 (±2.33). The biopsy sampling was diagnostic in 19/20 patients (95%).Conclusion:US-guided CNB represents a novel approach for the management of pSS patients with SGs enlargement. This procedure shows a remarkable patient safety and tolerance, allowing an adequate glandular sampling and definite diagnosis in almost all the studied patients.References:[1]Zabotti A, Zandonella Callegher S, Lorenzon M, Pegolo E, Scott CA, Tel A, et al. Ultrasound-guided core needle biopsy compared with open biopsy: a new diagnostic approach to salivary gland enlargement in Sjögren’s syndrome? Rheumatology (Oxford) 2020.[2]Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X; International Sjögren’s Syndrome Criteria Working Group. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren’s Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol. 2017 Jan;69(1):35-45. doi: 10.1002/art.39859. Epub 2016 Oct 26. PMID: 27785888; PMCID: PMC5650478.Table 1.Description of complicationsComplications of US-guided CNBPatients presenting complications, n/N (%)11/20 (55%)Description of transient complicationsSwelling at biopsy site, n2Bleeding, n1Hematoma, n1Local Pain, n7Local infection, n0Sialocele or fistula, n0Anaesthesia/paraesthesia, n0Transient facial palsy (< 1 hour), n1No persistent complications reportedAll the above specified complications were transient (< 12 weeks). No persistent complications were reported in the follow up.Figure 1.Post-biopsy complication QuestionnaireDisclosure of Interests:Alen Zabotti Speakers bureau: UCB, Novartis, Janssen, Paid instructor for: Amgen, Consultant of: Janssen, Ivan Giovannini: None declared, Sara Zandonella Callegher: None declared, Valeria Manfrè: None declared, Michele Lorenzon Consultant of: not relevant for this study, Enrico Pegolo: None declared, Cathryn Ann Scott: None declared, Alessandro Tel: None declared, Massimo Robiony Consultant of: not relevant for this study, Grant/research support from: not relevant for this study, Chiara Zuiani Consultant of: not relevant for this study, Grant/research support from: not relevant for this study, Salvatore De Vita Consultant of: GSK, Roche, Grant/research support from: not relevant for this study

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The determination of specificity, sensitivity and accuracy of core needle biopsy in the diagnosis of parotid and submandibular salivary glands tumors

Vojnosanitetski pregled ◽

10.2298/vsp170320001o ◽

2019 ◽

Vol 76 (9) ◽

pp. 921-928

Author(s):

Aleksandar Oroz ◽

Zorana Bokun ◽

Djordje Antonijevic ◽

Jasna Jevdjic

Keyword(s):

Salivary Gland ◽

Salivary Glands ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Tumor Tissue ◽

Submandibular Salivary Gland ◽

Histopathological Analysis ◽

Core Needle ◽

Parotid Salivary Gland ◽

Submandibular Salivary Glands

Background/Aim. The diagnosis of tumors of salivary glands relies heavily on radiological examination and biopsy of pathological tissue. The aim of this study was to investigate the sensitivity, specificity and accuracy of core needle biopsy in diagnosis of tumors of parotid and submandibular glands. Methods. This study was designed as a crosssectional clinical trial performed between May 2008 and ?ay 2015 at the Department of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center Zemun, Belgrade, Serbia. The examinations included 200 patients among which 100 were diagnosed with tumors of parotid salivary glands and 100 with tumors of submandibular salivary glands. The core needle biopsy was undertaken in all cases where tumor was smaller than 2 cm, far from blood vessels and far from the deep layer of parotid gland. The histopathological analysis was performed to identify histological type of the lesion. Upon performing the surgical procedure and consequently the tumor tissue extirpation, tissue samples obtained were investigated for the definitive diagnosis. Results. The sensitivity of the procedure was 90.9% for parotid salivary gland and 74% for submandibular salivary gland, the specificity was 95.9% for parotid salivary gland and 93% for submandibular salivary gland and the accuracy was 94.7% for parotid salivary gland and 87% for submandibular salivary gland. Based on the histopathological findings of the salivary glands obtained using core needle biopsy of the tumor tissue, it was possible to differentiate between malignant and benign lesions. Conclusion. Current investigation points to the advantages and efficiency of core needle biopsy in diagnosis of tumors of parotid and submandibular salivary glands.

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