Objective To evaluate the safety and utility of core needle biopsy (CNB) for diagnosis of salivary gland lymphoma in Sjögren’s syndrome (SS). Methods We analyzed data from consecutive SS patients who underwent ultrasound‐guided major salivary gland CNB for lymphoma diagnosis and determined whether CNB yielded an actionable diagnosis without need for further intervention. Results CNBs were performed in 24 patients to evaluate discrete parotid (n = 6) or submandibular (n = 2) gland masses or diffuse enlargement (n = 16; 15 parotid). One patient had 3 CNBs of the same mass. Of the 26 CNBs, 24 included flow cytometry, using CNB and/or fine needle aspirate material, and 14 targeted sonographically identified focal lesions. No patient reported complications. In the 23 patients with 1 CNB, final diagnoses were marginal zone lymphoma of mucosa‐associated lymphoid tissue (MALT; n = 6), atypical lymphoid infiltration (n = 3), benign lymphoepithelial sialadenitis (n = 9), normal gland tissue (n = 4), and lymphoepithelial cyst (n = 1). In the patient with serial CNBs, the initial one without flow cytometry was benign, but the next 2 showed atypical lymphoid infiltration. Monoclonal lymphoid infiltration was detected in 12 patients: 6 with MALT lymphoma, 3 were benign, and 3 with atypical lymphoid infiltration. Of the latter 3, 1 was treated with rituximab and 2 with expectant observation. The diagnosis changed from atypical lymphoid infiltration to MALT lymphoma in 1 patient following biopsy of inguinal adenopathy 6 months post‐CNB. CNB provided actionable results and avoided open excisional biopsies in all cases. Conclusion CNB is safe and useful in the evaluation of suspected salivary gland lymphoma in SS.
Ultrasonography (US) has been shown to be a sensitive tool to diagnose major salivary gland echotexture abnormalities in primary Sjögren9s syndrome (pSS).
Objectives
The purpose of this study was [1] to assess definitions of the different ultrasonographic components of the salivary glands and [2] to study the reliability of these definitions on static images with an international web exercice.
Methods
[1]The consensus exercice about definitions was done and discussed between 12 experts on the field of US pSS during 3 annual meetings. All experts were part of the US-pSS study group. [2]Using these preliminary definitions, a reliability exercice was done on static images. A centre (Brest- France) was in charge to send to the participants different representative US images collection of the agreed elementary lesions.30 parotid glands images and 30 submandibular glands images were sent to the experts by mail.They were asked to score each components of each glands in standardized file. Two rounds of exercicewere performed in order to obtain intra and inter reliability. The first round was in January 2014 and the second round was in March 2014. Inter and intra-observer agreements were estimated using the kappa index considering binary variables (agreements are almost perfect k:0.81 to 1.0; substantial: 0.61 to 0.8, moderate: 0.41 to 0.6, fair: 0.21 to 0.4, poor: -1.0 to 0.2).
Results
All experts were trained for US of salivary gland with at least 5 years of experience. We obtained definitions about 8 different components evaluating the abnormal parenchyma (echogenicity, homogenicity, presence or absence of hyperechoic bands, number of hypoechoic ares, and location of hypoechoic areas, lymph nodes, presence or absence of calcifications, visualisation of posterior border) on salivary glands in pSS patients. Results of the reliability web exercise is shown on table 1. Without practical training session, we showed good results concerning the intra and inter observer reliabilities applying these definitions on US parotid gland and submandibular glands, particularly in taking homogeneity as the main important item in this definition. Reliabilities for calcifications and posterior band were low.
Conclusions
This is the first consensus-based US definitions on salivary glands and its elementary components. These first results of the reliability exercice on static images without any training showed good results and permit to apply these preliminary definitions in routine practice and for further studies on pSS patients.
Magnetic resonance urographic (MRU) techniques possess image quality and diagnostic capability that are improving with increasingly sophisticated imaging sequences and shorter scanning times. We describe the application of a fast breath-hold MR sequence (HASTE) in the assessment of ureteric obstruction in pregnancy. In the patient presented, HASTE MRU was successful in depicting ureteral anatomy and demonstrated dilation of both ureters below the level of the pelvic brim. This observation suggested distal ureteral obstruction rather than simple hydronephrosis of pregnancy. As a result, bilateral nephrostomies were performed and neonatal prematurity was avoided. Interestingly, in this patient, HASTE MR imaging also showed evidence of concurrent fetal hydronephrosis.
Objectives Ultrasonography (US) is sensitive for detecting echostructural abnormalities of the major salivary glands (SGs) in primary Sjögren’s syndrome (pSS). Our objectives were to define selected US-SG echostructural abnormalities in pSS, set up a preliminary atlas of these definitions and evaluate the consensual definitions reliability in both static and acquisition US-SG images. Methods International experts in SG US in pSS participated in consensus meetings to select and define echostructural abnormalities in pSS. The US reliability of detecting these abnormalities was assessed using a two-step method. First 12 experts used a web-based standardised form to evaluate 60 static US-SG images. Intra observer and interobserver reliabilities were expressed in κ values. Second, five experts, who participated all throughout the study, evaluated US-SG acquisition interobserver reliability in pSS patients. Results Parotid glands (PGs) and submandibular glands (SMGs) intra observer US reliability on static images was substantial (κ > 0.60) for the two main reliable items (echogenicity and homogeneity) and for the advised pSS diagnosis. PG inter observer reliability was substantial for homogeneity. SMGs interobserver reliability was moderate for homogeneity (κ = 0.46) and fair for echogenicity (κ = 0.38). On acquisition images, PGs interobserver reliability was substantial (κ = 0.62) for echogenicity and moderate (κ = 0.52) for homogeneity. The advised pSS diagnosis reliability was substantial (κ = 0.66). SMGs interobserver reliability was fair (0.20< κ ≤ 0.40) for echogenicity and homogeneity and either slight or poor for all other US core items. Conclusion This work identified two most reliable US-SG items (echogenicity and homogeneity) to be used by US-SG trained experts. US-PG interobserver reliability result for echogenicity is in line with diagnosis of pSS.
