RMD open · 2025
Ultrasound-guided core needle biopsy of the parotid gland in Sjögren's disease: a promising tool towards precision medicine.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Achten Helena, Genbrugge Eva, Deroo Liselotte, Creytens David, Vanhaecke Amber, Deprez Joke, Dumas Emilie, Vanhoof Sophie, De Boeck Kristel, Bauters Wouter, Dochy Frederick, Roels Dimitri, Elewaut Dirk, Peene Isabelle
Аннотация
BACKGROUND: Disappointing outcomes in Sjögren's disease (SjD) trials underscore the need for reliable, sensitive endpoints. Histological assessment holds promise, but a minimally invasive, repeatable method for salivary gland tissue sampling is lacking.
OBJECTIVES: To evaluate the feasibility, safety and tissue adequacy of ultrasound-guided core needle biopsy (US-guided CNB) of the parotid gland and explore its role for facilitating histology-driven stratification and precision medicine.
METHODS: In the Belgian Sjögren's Syndrome Transition Trial, 66 patients (64 without gland swelling) underwent US-guided CNB. US was evaluated using OMERACT (Outcome Measures in Rheumatology Clinical Trials). and Hocevar scoring. Histopathology included assessment of focus score, B cell predominance (CD20>CD3), follicular dendritic cell networks (CD21), plasma cells (CD138), lymphoepithelial lesions (CK7/CK14) and FcRL4+ B cells. Pain was assessed using a visual analogue scale (VAS) from 0 to 10. Findings were matched with clinical data.
RESULTS: Mean VAS pain scores were 2.7 (SD=2.77) during biopsy and 1.9 (SD=2.33) in the 3 days before the follow-up call at day 14. No major complications occurred, and 82% of patients were willing to repeat the procedure. Adequate tissue was retrieved in 62/66 cases. Patients showed histological heterogeneity and were, as proof of concept, stratified into mild, moderate and severe histological involvement. Histological severity correlated with ultrasound scores (p<0.01) and not with traditional outcome measures (European Alliance of Associations for Rheumatology Sjögren's Syndrome Patient-Reported Index dryness and European Alliance of Associations for Rheumatology Sjögren's Syndrome Disease Activity Index).
CONCLUSION: US-guided CNB is safe, well-tolerated and yields adequate tissue. Beyond diagnostics, it might facilitate histology-driven patient stratification and advance precision medicine for SjD.
OBJECTIVES: To evaluate the feasibility, safety and tissue adequacy of ultrasound-guided core needle biopsy (US-guided CNB) of the parotid gland and explore its role for facilitating histology-driven stratification and precision medicine.
METHODS: In the Belgian Sjögren's Syndrome Transition Trial, 66 patients (64 without gland swelling) underwent US-guided CNB. US was evaluated using OMERACT (Outcome Measures in Rheumatology Clinical Trials). and Hocevar scoring. Histopathology included assessment of focus score, B cell predominance (CD20>CD3), follicular dendritic cell networks (CD21), plasma cells (CD138), lymphoepithelial lesions (CK7/CK14) and FcRL4+ B cells. Pain was assessed using a visual analogue scale (VAS) from 0 to 10. Findings were matched with clinical data.
RESULTS: Mean VAS pain scores were 2.7 (SD=2.77) during biopsy and 1.9 (SD=2.33) in the 3 days before the follow-up call at day 14. No major complications occurred, and 82% of patients were willing to repeat the procedure. Adequate tissue was retrieved in 62/66 cases. Patients showed histological heterogeneity and were, as proof of concept, stratified into mild, moderate and severe histological involvement. Histological severity correlated with ultrasound scores (p<0.01) and not with traditional outcome measures (European Alliance of Associations for Rheumatology Sjögren's Syndrome Patient-Reported Index dryness and European Alliance of Associations for Rheumatology Sjögren's Syndrome Disease Activity Index).
CONCLUSION: US-guided CNB is safe, well-tolerated and yields adequate tissue. Beyond diagnostics, it might facilitate histology-driven patient stratification and advance precision medicine for SjD.