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H. J. Kim, D. Chu, L. Frohman, N. Mirani, R. E. Turbin; Comparison of Histologic Change in Lacrimal and Salivary Glands to 67Ga-Citrate Scintigraphy and T1 Gadolinium Enhanced MRI Findings in Sarcoid Suspects. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4033.
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To correlate lacrimal gland (LGB) and oral (labial) minor salivary gland (SGB) biopsy findings in patients who have gallium or gadolinium uptake of the lacrimal glands (LG) and parotid glands (PG)performed to rule out sarcoid.
Retrospective chart review of consecutive patients (1/2003-11/2008) undergoing LGB and SGB. Inclusion criteria: available preoperative 67Ga-citrate scintigraphy (gallium) scan and/or MRI, and biopsy of LG and/or SG biopsy. Gallium uptake (LG, PG) and MRI (LG, PG) size were each graded into 4 categories. Histology was graded into 4 categories based on degree of inflammation, with the highest grade being granulomatous inflammation.
Forty-six patients (31 women, 15 men, average age 39) had both gallium and MRI scans in 25 cases, gallium alone in 19, and MRI alone in 2. Gallium scans showed increased LG uptake in 42, parotid uptake in 35, and submandibular uptake in 4. MRI showed abnormal LG in 8 cases and abnormal parotid in 7 cases. Granulomatous inflammation was seen in 11 cases (4 in both LG and SG, 5 in LG only, 2 in SG only). 8 granulomatous LGs had associated gallium scans that showed intense uptake in 4, moderate in 3, and mild uptake in 1. 12 of 13 patients with severe grade gallium abnormality (LG or PG) had no higher than mild grade biopsy results (SGB or LGB), and 1 had moderate grade inflammation (SGB or LGB). MRI findings in granulomatous LGs were moderate in 1 case, mild in 2, and normal in 1. Granulomatous inflammation in SG had intense PG gallium uptake in 3, moderate uptake in 1 and mild in 1, and had severe abnormalities on MRI in 1, and normal MRI in 2.
67Ga-citrate scintigraphy (gallium) scan and MRI are sensitive in identifying inflammatory reaction but less specific for identifying granulomatous change in LG and in SG. Surgeons may consider SG biopsy in conjunction with LG biopsy as SG may have diagnostic value even when the imaging and LG biopsy are unremarkable. Ultimately, sarcoidosis is a clinical diagnosis and LG and SG biopsies remain a useful confirmatory test.
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