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

Background: Enlargement 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.

Objective: Accordingly, 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.

Methods: Patients 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).

Results: US-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.

Conclusion: US-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.

Keywords: Sjogren's syndrome; autoimmune diseases; ultrasonography.

Figure 1

Sonographic images of a focal lesion (the white arrows) in the salivary gland parenchyma (A); a peculiar appearance of the salivary gland, showing confluent hypoechoic areas (B).

Figure 2

The ‘safety area’ or ‘safety zone’ (green area) for a parotid biopsy.

Figure 3

(A): A patient’s supine positioning for a parotid gland CNB, with their shoulders slightly lifted (and a pillow below their upper back), slight hyperextension of their neck and facing towards the contralateral side of the target gland. (B): Local anaesthetic injected under ultrasound guidance into the subcutaneous tissue and the posterior, superficial part of the parotid gland while moving the needle in a caudocranial direction. (C): A semi-automatic needle inserted into the ‘safety area’ of the left parotid gland. (D): A semi-automatic needle inserted into the left submandibular gland, (E): The needle’s sonographic appearance in a focal lesion of the parotid gland. (F): The needle’s sonographic appearance in a peculiar appearance of the salivary gland, in the absence of focal lesion. CNB, core needle biopsy.

Figure 4

(A) Complications of US-guided CNB; all complications were transient (<12 weeks), and no persistent complications were reported during follow-up. (B): Peri-procedural pain: patients’ reported intra- and post-operative pain. CNB, core needle biopsy; US, ultrasound.