The diagnostic utility of submandibular gland sonography and labial salivary gland biopsy in IgG4-related dacryoadenitis and sialadenitis

Its potential application to the diagnostic criteria

Mizuki Sakamoto, Masafumi Moriyama, Mayumi Shimizu, Akira Chinju, Keita Mochizuki, Ryusuke Munemura, Keiko Ohyama, takashi maehara, Kenichi Ogata, Miho Ohta, Masaki Yamauchi, Noriko Ishiguro, Mayu Matsumura, Yukiko Ohyama, Tamotsu Kiyoshima, Seiji Nakamura

Research output: Contribution to journalArticle

Abstract

Objectives: In this study, we investigated the diagnostic utility of submandibular gland (SMG) sonography and labial salivary gland (LSG) biopsy as a less invasive procedure for diagnosing IgG4-related dacryoadenitis and sialadenitis (IgG4-DS) Methods: Sixty-eight patients with suspected IgG4-DS by presenting swelling of elevated serum IgG (>1747 mg/dl) and/or swelling glands underwent SMG sonography, LSG biopsy and measurement for serum IgG4. SMG sonographic diagnosis was determined by the following characteristic changes; ‘hypoechoic areas of a nodal pattern with high vascularity’ and/or ‘hypoechoic areas of a reticular pattern in the superficial part’. Results: Thirty-one patients were diagnosed with IgG4-DS, 5 with IgG4-RD unaccompanied by lacrimal and salivary gland lesions, 28 with Sjögren’s syndrome, and 4 with malignant lymphoma. The sensitivity, specificity, and accuracy of SMG sonography and LSG biopsy were 100%, 83.8%, 91.2% and 64.5%, 73.8%, 75.0%, respectively. Moreover, those of SMG sonography and LSG biopsy combined with serum IgG4 concentration (>135 mg/dl) were 100%, 94.6%, 97.1% and 64.5%, 91.9%, 79.4%, respectively. Conclusion: LSG biopsy needs to be extremely careful to diagnose IgG4-DS because of its low sensitivity. SMG sonography is sufficient for the diagnosis of IgG4-DS, especially when combined with serologic analysis. Thus, SMG sonography could adapt to the diagnostic criteria of IgG4-DS as a non-invasive method.

Original languageEnglish
JournalModern Rheumatology
DOIs
Publication statusPublished - Jan 1 2019

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Dacryocystitis
Sialadenitis
Submandibular Gland
Lip
Salivary Glands
Ultrasonography
Immunoglobulin G
Biopsy
Serum
Lacrimal Apparatus
Lymphoma

All Science Journal Classification (ASJC) codes

  • Rheumatology

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The diagnostic utility of submandibular gland sonography and labial salivary gland biopsy in IgG4-related dacryoadenitis and sialadenitis : Its potential application to the diagnostic criteria. / Sakamoto, Mizuki; Moriyama, Masafumi; Shimizu, Mayumi; Chinju, Akira; Mochizuki, Keita; Munemura, Ryusuke; Ohyama, Keiko; maehara, takashi; Ogata, Kenichi; Ohta, Miho; Yamauchi, Masaki; Ishiguro, Noriko; Matsumura, Mayu; Ohyama, Yukiko; Kiyoshima, Tamotsu; Nakamura, Seiji.

In: Modern Rheumatology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Objectives: In this study, we investigated the diagnostic utility of submandibular gland (SMG) sonography and labial salivary gland (LSG) biopsy as a less invasive procedure for diagnosing IgG4-related dacryoadenitis and sialadenitis (IgG4-DS) Methods: Sixty-eight patients with suspected IgG4-DS by presenting swelling of elevated serum IgG (>1747 mg/dl) and/or swelling glands underwent SMG sonography, LSG biopsy and measurement for serum IgG4. SMG sonographic diagnosis was determined by the following characteristic changes; ‘hypoechoic areas of a nodal pattern with high vascularity’ and/or ‘hypoechoic areas of a reticular pattern in the superficial part’. Results: Thirty-one patients were diagnosed with IgG4-DS, 5 with IgG4-RD unaccompanied by lacrimal and salivary gland lesions, 28 with Sj{\"o}gren’s syndrome, and 4 with malignant lymphoma. The sensitivity, specificity, and accuracy of SMG sonography and LSG biopsy were 100{\%}, 83.8{\%}, 91.2{\%} and 64.5{\%}, 73.8{\%}, 75.0{\%}, respectively. Moreover, those of SMG sonography and LSG biopsy combined with serum IgG4 concentration (>135 mg/dl) were 100{\%}, 94.6{\%}, 97.1{\%} and 64.5{\%}, 91.9{\%}, 79.4{\%}, respectively. Conclusion: LSG biopsy needs to be extremely careful to diagnose IgG4-DS because of its low sensitivity. SMG sonography is sufficient for the diagnosis of IgG4-DS, especially when combined with serologic analysis. Thus, SMG sonography could adapt to the diagnostic criteria of IgG4-DS as a non-invasive method.",
author = "Mizuki Sakamoto and Masafumi Moriyama and Mayumi Shimizu and Akira Chinju and Keita Mochizuki and Ryusuke Munemura and Keiko Ohyama and takashi maehara and Kenichi Ogata and Miho Ohta and Masaki Yamauchi and Noriko Ishiguro and Mayu Matsumura and Yukiko Ohyama and Tamotsu Kiyoshima and Seiji Nakamura",
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T2 - Its potential application to the diagnostic criteria

AU - Sakamoto, Mizuki

AU - Moriyama, Masafumi

AU - Shimizu, Mayumi

AU - Chinju, Akira

AU - Mochizuki, Keita

AU - Munemura, Ryusuke

AU - Ohyama, Keiko

AU - maehara, takashi

AU - Ogata, Kenichi

AU - Ohta, Miho

AU - Yamauchi, Masaki

AU - Ishiguro, Noriko

AU - Matsumura, Mayu

AU - Ohyama, Yukiko

AU - Kiyoshima, Tamotsu

AU - Nakamura, Seiji

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: In this study, we investigated the diagnostic utility of submandibular gland (SMG) sonography and labial salivary gland (LSG) biopsy as a less invasive procedure for diagnosing IgG4-related dacryoadenitis and sialadenitis (IgG4-DS) Methods: Sixty-eight patients with suspected IgG4-DS by presenting swelling of elevated serum IgG (>1747 mg/dl) and/or swelling glands underwent SMG sonography, LSG biopsy and measurement for serum IgG4. SMG sonographic diagnosis was determined by the following characteristic changes; ‘hypoechoic areas of a nodal pattern with high vascularity’ and/or ‘hypoechoic areas of a reticular pattern in the superficial part’. Results: Thirty-one patients were diagnosed with IgG4-DS, 5 with IgG4-RD unaccompanied by lacrimal and salivary gland lesions, 28 with Sjögren’s syndrome, and 4 with malignant lymphoma. The sensitivity, specificity, and accuracy of SMG sonography and LSG biopsy were 100%, 83.8%, 91.2% and 64.5%, 73.8%, 75.0%, respectively. Moreover, those of SMG sonography and LSG biopsy combined with serum IgG4 concentration (>135 mg/dl) were 100%, 94.6%, 97.1% and 64.5%, 91.9%, 79.4%, respectively. Conclusion: LSG biopsy needs to be extremely careful to diagnose IgG4-DS because of its low sensitivity. SMG sonography is sufficient for the diagnosis of IgG4-DS, especially when combined with serologic analysis. Thus, SMG sonography could adapt to the diagnostic criteria of IgG4-DS as a non-invasive method.

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