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Shear wave elastography as a new method to identify parotid lymphoma in primary Sjögren Syndrome patients: an observational study

  • Observational Research
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Abstract

Parotid non-Hodgkin lymphoma (NHL) in primary Sjögren syndrome (pSS) has no specific biomarker for diagnosis. Salivary glands ultrasound (US) is largely used, but its contribution in detecting parotid NHL has not been established. The aim of our study was to determine the added value of bidimensional shear wave elastography (2D-SWE) in pSS diagnosis and to determine its accuracy in identifying parotid NHL. Grey-scale US (GSUS) and 2D-SWE of salivary glands were performed in 35 patients with pSS and 35 healthy controls. The GSUS scores were calculated and the mean of three SWE consecutive measurements was used to appreciate the gland stiffness. SWE increase the diagnostic rate at a cut-off of 6.45 kPa (from 88.6 to 94.2%, p < 0.001) only if applied in patients with insufficient GSUS criteria for pSS diagnosis. The parotid glands with NHL (8 patients, all mucosa-associated lymphoid tissue type) had hyperechoic bands in more than half of the glandular parenchyma (in 68.75% of the glands), large hypoechoic area > 20 mm (all glands), traced gland area over 5 cm2 (all glands), parotid US score greater than 13 (in 68.75% of the glands), and high stiffness (elasticity modulus 13.9 ± 4.08 vs 6.32 ± 2.24) (all p < 0.001). These findings give high sensitivity (92.3%), specificity (100%), and positive (100%) and negative predictive values (98.3%) for NHL identification. The rest of GSUS findings did not correlate with the classic risk factors for lymphoma development (all p > 0.05). 2D-SWE had added value for pSS diagnosis in cases where GSUS aspect is normal or nonspecific. The higher stiffness of parotid NHL can be used for early diagnosis, biopsy guidance, and, possible, for treatment monitoring.

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Acknowledgements

We would like to thank to Mr. George Dobre from Pondera Medical that supported our study with the US machine and gave technological advices.

Funding

This work was supported by “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Grant number [1680/7/19.01.2018].

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Author notes

  1. Maria Bădărînză and Oana Serban shared the first authorship

Authors and Affiliations

  1. Second Internal Medicine Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 2-4 Clinicilor street, 400006, Cluj Napoca, Romania

    Maria Bădărînză, Oana Serban, Lavinia Maghear, Corina Bocsa & Daniela Fodor

  2. Rheumatology Division, Rehabilitation Clinical Hospital, Cluj-Napoca, Romania

    Mihaela Micu

  3. Rheumatology Division, Emergency Clinical County Hospital, Cluj-Napoca, Romania

    Laura Damian & Ioana Felea

Authors
  1. Maria Bădărînză
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Contributions

Conception and design of the study: MB, OS, DF. Data collection, acquisition, analysis, and interpretation of data for the study: MB OS, LM, CB, MM, DF. Statistical analysis: OS. Drafting the work and manuscript preparation: MB, LD, IF, DF. Manuscript revision: LD, OS, MM, DF. All authors approved the final version of manuscript.

Corresponding author

Correspondence to Daniela Fodor.

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The authors declare that they have no conflict of interest.

Ethical approval

All patients gave written informed consent in accordance with the declaration of Helsinki. Approval was obtained from the ethics committee of University of Medicine and Pharmacy “Iuliu Hatieganu" Cluj-Napoca (Date of approval: 2 April 2018/No. of approval 166).

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Bădărînză, M., Serban, O., Maghear, L. et al. Shear wave elastography as a new method to identify parotid lymphoma in primary Sjögren Syndrome patients: an observational study. Rheumatol Int 40, 1275–1281 (2020). https://doi.org/10.1007/s00296-020-04548-x

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  • DOI: https://doi.org/10.1007/s00296-020-04548-x

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