Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Dentistry and Oral surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Clin Exp Rheumatol. 2020 Jul-Aug;38 Suppl 126(4):210-215. Epub 2020 Oct 23.
Ultra-high frequency ultrasonography (UHFUS) has been recently introduced in oral medicine due to its ability to image small anatomical structures including labial salivary glands (LSG). To date no ultrasonography morphological studies of labial salivary glands (LSG) have been carried out in SS. In this pilot study we aimed at analysing the distribution of UHFUS findings in LSG of patients with suspected SS, focusing in particular on the association with patients' oral dysfunction, antibody profiles and histopathology.
Consecutive patients undergoing a LSG biopsy for clinically suspected SS were included in this study between January 2018 and January 2020. Intraoral UHFUS scan of the lip mucosa was performed with Vevo MD equipment, using a 70 MHz probe with a standardised protocol. LSG were assessed by using a four-grade semiquantitative scoring system (0-3), similar to the OMERACT scoring system used for major salivary glands. The distribution of UHFUS grades was compared in patients stratified according their final diagnosis, patients antibody profiles and LSG histopathology.
We included 128 patients with suspected SS: out of them, 54 (42.2%) received a final diagnosis of SS, made according to the ACR 2016 criteria and 74 (57.8%) were diagnosed as no-SS sicca controls. We found that LSG inhomogeneity was significantly greater in patients with SS than in no-SS subjects (p<0.0001). We also found that higher UHFUS pattern of inhomogeneity (i.e. grade 2 and 3) were significantly more frequent in both SSA+/SSB- and SSA+/SSB+ patients (p=0.001). A normal UHFUS pattern, by contrast, was significantly more common in SSA-/SSB- subjects (i.e. 15/83 (18.1%) vs. 1/33 (3%) vs. 0/12 (0%), p=0.001). Finally, LSG inhomogeneity was significantly associated with both the number of foci (p<0.001) and focus score (p<0.001). Particularly, we found that both the number of foci and the FS were significantly higher in patients presenting a UHFUS grading of 2 and 3 with respect to those presenting a UHFUS grading of 0 and 1 (p=0.01).
This preliminary study demonstrates the optimal feasibility of UHFUS and its high sensitivity in identifying negative patients on subsequent lip biopsy, thus avoiding invasive procedures in selected cases. Further studies are in progress to define the clinical and predictive role of the various patterns observed and their added value with respect to traditional salivary gland ultrasonography.
由于能够对包括唇唾液腺（LSG）在内的小解剖结构进行成像，超高频率超声（UHFUS）最近在口腔医学中得到了应用。迄今为止，还没有关于唇唾液腺（LSG）的超声形态学研究在 SS 中进行。在这项初步研究中，我们旨在分析疑似 SS 患者 LSG 的 UHFUS 发现分布，特别关注其与患者口腔功能障碍、抗体谱和组织病理学的关联。
本研究纳入了 2018 年 1 月至 2020 年 1 月期间因临床疑似 SS 而行 LSG 活检的连续患者。使用 Vevo MD 设备对内唇黏膜进行口腔内 UHFUS 扫描，使用标准协议的 70 MHz 探头。使用类似于 OMERACT 评分系统用于主要唾液腺的四级半定量评分系统（0-3）评估 LSG。根据最终诊断、患者抗体谱和 LSG 组织病理学对患者进行分层，比较 UHFUS 分级的分布。
我们纳入了 128 名疑似 SS 的患者：其中 54 名（42.2%）根据 ACR 2016 标准诊断为 SS，74 名（57.8%）诊断为非 SS 干燥对照。我们发现 SS 患者的 LSG 不均匀性明显大于非 SS 患者（p<0.0001）。我们还发现，更高的 UHFUS 不均匀模式（即 2 级和 3 级）在 SSA+/SSB-和 SSA+/SSB+患者中更为常见（p=0.001）。相反，正常的 UHFUS 模式在 SSA-/SSB-受试者中更为常见（即 15/83（18.1%）比 1/33（3%）比 0/12（0%），p=0.001）。最后，LSG 不均匀性与病灶数量（p<0.001）和病灶评分（p<0.001）显著相关。特别是，我们发现与 UHFUS 分级 0 和 1 相比，UHFUS 分级 2 和 3 的患者病灶数量和 FS 均显著更高（p=0.01）。
这项初步研究证明了 UHFUS 的最佳可行性及其在后续唇部活检中识别阴性患者方面的高灵敏度，从而避免了在选定病例中进行有创性操作。目前正在进行进一步的研究，以确定观察到的各种模式的临床和预测作用及其相对于传统唾液腺超声的附加价值。
