Advertisement

Utility of navigation system-guided submandibular gland core needle biopsy in the diagnosis of immunoglobulin G4-related sialadenitis

Published:January 20, 2023DOI:https://doi.org/10.1016/j.ijom.2023.01.007

      Abstract

      Pathological diagnosis is important for the definite diagnosis of immunoglobulin G4-related sialadenitis (IgG4-RS). Core needle biopsy (CNB) is a scarless technique; however the pathological heterogeneity of IgG4-RS (a particular feature of this disease) could be the potential cause of the inferior diagnostic capability of submandibular gland CNB (SMG-CNB) for IgG4-RS. The aim of this study was to explore technical improvements in SMG-CNB and improve its diagnostic power in IgG4-RS diagnosis. Eighteen patients clinically suspected for IgG4-RS were enrolled and underwent both SMG-CNB and SMG surgical biopsy. A navigation system (Brainlab) was employed during SMG-CNB to obtain representative samples and avoid blood vessel injury. Histopathological and immunopathological findings for the SMG-CNB samples were in good concordance with SMG surgical biopsy. There was no statistically significant difference between SMG-CNB and SMG surgical biopsy in IgG-positive cell count (132.4 ± 59.3 vs 132.2 ± 47.5, P = 0.99), IgG4-positive cell count (102.2 ± 39.7 vs 97.2 ± 27.6, P = 0.67), or IgG4-positive/IgG-positive cell count ratio (78.6% ± 0.1% vs 75.2% ± 0.1%, P = 0.29). A moderate or strong significant correlation was found between SMG-CNB and SMG surgical biopsy for these cell counts and ratio (all P < 0.01). The diagnostic consistency of SMG-CNB and SMG surgical biopsy was 100%. The Brainlab navigation system may assist in collecting representative SMG-CNB samples from typical pathological lesions. Tissues obtained from SMG-CNB are sufficient for the pathological diagnosis of IgG4-RS. Standardized SMG-CNB is expected to replace SMG surgical biopsy for IgG4-RS diagnosis.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Stone J.H.
        • Zen Y.
        • Deshpande V.
        IgG4-related disease.
        N Engl J Med. 2012; 366: 539-551https://doi.org/10.1056/NEJMra1104650
        • Li W.
        • Chen Y.
        • Sun Z.P.
        • Cai Z.G.
        • Li T.T.
        • Zhang L.
        • Huang M.X.
        • Hua H.
        • Li M.
        • Hong X.
        • Su J.Z.
        • Zhang Z.Y.
        • Liu Y.Y.
        • He J.
        • Li Z.G.
        • Gao Y.
        • Yu G.Y.
        Clinicopathological characteristics of immunoglobulin G4-related sialadenitis.
        Arthritis Res Ther. 2015; 17: 186https://doi.org/10.1186/s13075-015-0698-y
        • Umehara H.
        • Okazaki K.
        • Masaki Y.
        • Kawano M.
        • Yamamoto M.
        • Saeki T.
        • Matsui S.
        • Yoshino T.
        • Nakamura S.
        • Kawa S.
        • Hamano H.
        • Kamisawa T.
        • Shimosegawa T.
        • Shimatsu A.
        • Nakamura S.
        • Ito T.
        • Notohara K.
        • Sumida T.
        • Tanaka Y.
        • Mimori T.
        • Chiba T.
        • Mishima M.
        • Hibi T.
        • Tsubouchi H.
        • Inui K.
        • Ohara H.
        Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011.
        Mod Rheumatol. 2012; 22: 21-30https://doi.org/10.1007/s10165-011-0571-z
        • Wallace Z.S.
        • Naden R.P.
        • Chari S.
        • Choi H.K.
        • Della-Torre E.
        • Dicaire J.F.
        • Hart P.A.
        • Inoue D.
        • Kawano M.
        • Khosroshahi A.
        • Lanzillotta M.
        • Okazaki K.
        • Perugino C.A.
        • Sharma A.
        • Saeki T.
        • Schleinitz N.
        • Takahashi N.
        • Umehara H.
        • Zen Y.
        • Stone J.H.
        Members of the ACR/EULAR IgG4-RD Classification Criteria Working Group. The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease.
        Ann Rheum Dis. 2020; 79: 77-87https://doi.org/10.1136/annrheumdis-2019-216561
        • Khosroshahi A.
        • Wallace Z.S.
        • Crowe J.L.
        • Akamizu T.
        • Azumi A.
        • Carruthers M.N.
        • Chari S.T.
        • Della-Torre E.
        • Frulloni L.
        • Goto H.
        • Hart P.A.
        • Kamisawa T.
        • Kawa S.
        • Kawano M.
        • Kim M.H.
        • Kodama Y.
        • Kubota K.
        • Lerch M.M.
        • Lohr M.
        • Masaki Y.
        • Matsui S.
        • Mimori T.
        • Nakamura S.
        • Nakazawa T.
        • Ohara H.
        • Okazaki K.
        • Ryu J.H.
        • Saeki T.
        • Schleinitz N.
        • Shimatsu A.
        • Shimosegawa T.
        • Takahashi H.
        • Takahira M.
        • Tanaka A.
        • Topazian M.
        • Umehara H.
        • Webster G.J.
        • Witzig T.E.
        • Yamamoto M.
        • Zhang W.
        • Chiba T.
        • Stone J.H.
        Second International Symposium on IgG4-Related Disease. International consensus guidance statement on the management and treatment of IgG4-related disease.
        Arthritis Rheumatol. 2015; 67: 1688-1699https://doi.org/10.1002/art.39132
        • Liu Y.
        • Yang F.
        • Chi X.
        • Zhang Y.
        • Fu J.
        • Bian W.
        • Shen D.
        • Li Z.
        Needle biopsy compared with surgical biopsy: pitfalls of small biopsy in histological diagnosis of IgG4-related disease.
        Arthritis Res Ther. 2021; 2354https://doi.org/10.1186/s13075-021-02432-y
        • Vitali C.
        • Bombardieri S.
        • Jonsson R.
        • Moutsopoulos H.M.
        • Alexander E.L.
        • Carsons S.E.
        • Daniels T.E.
        • Fox P.C.
        • Fox R.I.
        • Kassan S.S.
        • Pillemer S.R.
        • Talal N.
        • Weisman M.H.
        European Study Group on Classification Criteria for Sjögren’s Syndrome. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American–European consensus group.
        Ann Rheum Dis. 2002; 61: 554-558https://doi.org/10.1136/ard.61.6.554
        • Zhang Y.Y.
        • Hong X.
        • Wang Z.
        • Li W.
        • Su J.Z.
        • Chen Y.
        • Gao Y.
        • Yu G.Y.
        Diagnostic utility of submandibular and labial salivary gland biopsy in IgG4-related sialadenitis.
        Clin Rheumatol. 2020; 39: 3715-3721https://doi.org/10.1007/s10067-020-05097-1
        • Akiyama M.
        • Kaneko Y.
        • Hayashi Y.
        • Takeuchi T.
        IgG4-related disease involving vital organs diagnosed with lip biopsy: a case report and literature review.
        Medicine. 2016; 95e3970https://doi.org/10.1097/MD.0000000000003970
        • Ogawa Y.
        • Nakagawa M.
        • Ishii W.
        • Ikeda S.
        Lip biopsy in Mikulicz’s disease phenotype IgG4-related disease.
        Intern Med. 2013; 52: 1007-1008https://doi.org/10.2169/internalmedicine.52.9443
        • Takano K.
        • Keira Y.
        • Seki N.
        • Abe A.
        • Yamamoto M.
        • Takahashi H.
        • Himi T.
        Evaluation of submandibular versus labial salivary gland fibrosis in IgG4-related disease.
        Mod Rheumatol. 2014; 24: 1023-1025https://doi.org/10.3109/14397595.2013.853336
        • Moriyama M.
        • Furukawa S.
        • Kawano S.
        • Goto Y.
        • Kiyoshima T.
        • Tanaka A.
        • Maehara T.
        • Hayashida J.N.
        • Ohta M.
        • Nakamura S.
        The diagnostic utility of biopsies from the submandibular and labial salivary glands in IgG4-related dacryoadenitis and sialoadenitis, so-called Mikulicz’s disease.
        Int J Oral Maxillofac Surg. 2014; 43: 1276-1281https://doi.org/10.1016/j.ijom.2014.06.014
        • Takano K.
        • Nomura K.
        • Abe A.
        • Kamekura R.
        • Yamamoto M.
        • Ichimiya S.
        • Takahashi H.
        • Himi T.
        Clinicopathological analysis of salivary gland tissue from patients with IgG4-related disease.
        Acta Otolaryngol. 2016; 136: 717-721https://doi.org/10.3109/00016489.2016.1154605
        • Detlefsen S.
        • Mortensen M.B.
        • Pless T.K.
        • Cribe A.S.
        • de Muckadell O.B.
        Laparoscopic and percutaneous core needle biopsy plays a central role for the diagnosis of autoimmune pancreatitis in a single-center study from Denmark.
        Pancreas. 2015; 44: 845-858https://doi.org/10.1097/MPA.0000000000000312
        • Ogiya A.
        • Tanaka K.
        • Tadokoro Y.
        • Kikutani M.
        • Uematsu T.
        • Kashiwagi H.
        • Kasami M.
        • Takahashi K.
        IgG4-related sclerosing disease of the breast successfully treated by steroid therapy.
        Breast Cancer. 2014; 21: 231-235https://doi.org/10.1007/s12282-010-0225-6
        • Hirano K.
        • Fukushima N.
        • Tada M.
        • Isayama H.
        • Mizuno S.
        • Yamamoto K.
        • Yashima Y.
        • Yagioka H.
        • Sasaki T.
        • Kogure H.
        • Nakai Y.
        • Sasahira N.
        • Tsujino T.
        • Kawabe T.
        • Fukayama M.
        • Omata M.
        Diagnostic utility of biopsy specimens for autoimmune pancreatitis.
        J Gastroenterol. 2009; 44: 765-773https://doi.org/10.1007/s00535-009-0052-8
        • Li W.
        • Xie X.Y.
        • Su J.Z.
        • Hong X.
        • Chen Y.
        • Gao Y.
        • Zhang Z.Y.
        • Yu G.Y.
        Ultrasonographic features of immunoglobulin G4-related sialadenitis.
        Ultrasound Med Biol. 2016; 42: 167-175https://doi.org/10.1016/j.ultrasmedbio.2015.09.014
        • Lin W.
        • Lu S.
        • Chen H.
        • Wu Q.
        • Fei Y.
        • Li M.
        • Zhang X.
        • Tian X.
        • Zheng W.
        • Leng X.
        • Xu D.
        • Wang Q.
        • Shen M.
        • Wang L.
        • Li J.
        • Wu D.
        • Zhao L.
        • Wu C.
        • Yang Y.
        • Peng L.
        • Zhou J.
        • Wang Y.
        • Sha Y.
        • Huang X.
        • Jiao Y.
        • Zeng X.
        • Shi Q.
        • Li P.
        • Zhang S.
        • Hu C.
        • Deng C.
        • Li Y.
        • Zhang S.
        • Liu J.
        • Su J.
        • Hou Y.
        • Jiang Y.
        • You X.
        • Zhang H.
        • Yan L.
        • Zhang W.
        • Zhao Y.
        • Zeng X.
        • Zhang F.
        • Lipsky P.E.
        Clinical characteristics of immunoglobulin G4-related disease: a prospective study of 118 Chinese patients.
        Rheumatology. 2015; 54: 1982-1990https://doi.org/10.1093/rheumatology/kev203
        • Moriyama M.
        • Ohta M.
        • Furukawa S.
        • Mikami Y.
        • Tanaka A.
        • Maehara T.
        • Yamauchi M.
        • Ishiguro N.
        • Hayashida J.N.
        • Kawano S.
        • Ohyama Y.
        • Kiyoshima T.
        • Nakamura S.
        The diagnostic utility of labial salivary gland biopsy in IgG4-related disease.
        Mod Rheumatol. 2016; 26: 725-729https://doi.org/10.3109/14397595.2016.1148225