Keywords:
Haematologic, Head and neck, Salivary glands, Ultrasound, Ultrasound-Colour Doppler, Education, Haematologic diseases, Lymphoma
Authors:
F. Tulipano Di Franco, M. Lorenzon, A. Zabotti, S. Zandonella Callagher, E. Pegolo, C. Di Loreto, S. De Vita, R. Girometti, C. Zuiani; Udine/IT
DOI:
10.26044/ecr2021/C-10893
Methods and materials
Patients
This study was approved by the referring Institutional review board. Written informed consent was obtained from each patient in accordance with the Declaration of Helsinki and with local guidelines for good clinical practice. In this prospective study, from September 2019 to October 2020, fifteen consecutive patients with definite (ACR-EULAR classification criteria) or clinically suspected pSS and with clinical and/or laboratoristic and/or US findings suspicious for MALT lymphoma were referred to our Institute to undergo a US evaluation of their major SGs followed by US-guided CNB. In nine of these patients the biopsy confirmed the presence of MALT lymphoma. These nine patients (8 females and 1 male, mean age 67,9 years) were included in our study. The flowchart of the study is reported in Fig 1.
Ultrasound examination and US-guided CNB
Both the US examination and the CNB were performed by one radiologist with 10 years of experience in US of the major SGs and US-guided CNB of superficial lesions, using an Affiniti 70 system (Philips, Eindhoven, the Netherlands) equipped with a linear high-frequency transducer (L18-5 MHz). For the biopsies, a 14-gauge semi-automatic CNB system was used (Precisa 14G, HS Hospital Service, Aprilia, Italy); the sampling length was set on 20 mm. US examination was focused on the most swollen gland, if enlargement was present, and performed in the supine position, with a slight hyperextension of the neck. All the patients were cooperative. Images and cine-loops were digitally archived.
Image analysis
Imaging analysis was performed on the recorded images by the same radiologist that performed the preliminary US, using a dedicated workstation (SuiteEstensa release 2.0, v 33.6.3.1, EBIT – Esaote Group, Genoa, Italy). The US features of the SGs were recorded according to OMERACT score [9]. For each MALT lymphoma the following features were assessed: 1) echogenicity (hypo- / iso- / hyper-echoic) 2) inner appearance (homogeneous / inhomogeneous) 3) shape (oval / round / lobulated), 4) margins (well-defined or ill-defined), 5) presence of septa (present or absent), 6) vascularization (present or absent at color-Doppler assessment), 7) posterior acoustic features (posterior enhancement / posterior shadowing / none). A descriptive analysis was performed and the frequency of all these features was then reported.