Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2017; 23(18): 3295-3300
Published online May 14, 2017. doi: 10.3748/wjg.v23.i18.3295
Clinical significance of hypoechoic submandibular gland lesions in type 1 autoimmune pancreatitis
Shinichi Takano, Mitsuharu Fukasawa, Makoto Kadokura, Hiroko Shindo, Ei Takahashi, Sumio Hirose, Yoshimitsu Fukasawa, Satoshi Kawakami, Tadashi Sato, Nobuyuki Enomoto
Shinichi Takano, Mitsuharu Fukasawa, Makoto Kadokura, Hiroko Shindo, Ei Takahashi, Sumio Hirose, Yoshimitsu Fukasawa, Satoshi Kawakami, Tadashi Sato, Nobuyuki Enomoto, First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
Author contributions: Takano S designed and performed the research and wrote the paper; Sato T designed the research and supervised the report; Fukasawa M, Kadokura M, Shindo H, Takahashi E, Hirose S, Fukasawa Y, Kawakami S and Enomoto N provided clinical advice.
Institutional review board statement: This retrospective study was approved by the ethics committee of Yamanashi University Hospital.
Informed consent statement: The ethics committee waived the requirement for written informed consent because the study was a retrospective data analysis, with appropriate consideration given to patient risk, privacy, welfare, and rights.
Conflict-of-interest statement: The authors report no financial conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tadashi Sato, MD, PhD, Associate Professor, First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi 409-3898, Japan. tadashis@yamanashi.ac.jp
Telephone: +81-55-2739584 Fax: +81-55-2736748
Received: December 26, 2017
Peer-review started: December 27, 2017
First decision: February 10, 2017
Revised: March 12, 2017
Accepted: April 21, 2017
Article in press: April 21, 2017
Published online: May 14, 2017
Abstract
AIM

To assess the role of ultrasonography of submandibular glands (SGs) in the diagnosis of type 1 autoimmune pancreatitis (AIP).

METHODS

Thirty-seven patients who were definitively diagnosed with type 1 AIP according to the international consensus diagnostic criteria (ICDC) for AIP at our institution between December 1990 and April 2016 were retrospectively reviewed. Findings by physical examination, ultrasonography, and scintigraphy of SGs were analyzed to reach a diagnosis based on the ICDC for AIP. The efficacy of corticosteroid treatment in the resolution of hypoechoic lesions in SGs was also evaluated by assessment with ultrasonography before and after treatment in 18 cases.

RESULTS

The sensitivity of multiple hypoechoic lesions in SGs by ultrasonography for the diagnosis of sialadenitis in type 1 AIP (84%) was higher than that of physical examination (46%), scintigraphy (28%), and SGs thickness (49%). Ultrasonographic evidence of hypoechoic lesions in SGs improved the definitive diagnosis of sialadenitis and type 1 AIP by the ICDC criteria in 11 (30%) and 2 (5.4%) cases, respectively. Multiple hypoechoic lesions in SGs were resolved or disappear by corticosteroid administration in 14 of 16 cases with hypoechoic lesions in SGs, whereas the ultrasonographic findings in the remaining 2 cases with hypoechoic lesions in SGs and the 2 cases with homogenous SG parenchyma remained unchanged after corticosteroid administration.

CONCLUSION

SG ultrasonography to detect multiple hypoechoic lesions might be useful for type 1 AIP diagnosis by improving diagnostic accuracy together with the ICDC sialadenitis criteria.

Keywords: Autoimmune pancreatitis, Ultrasonography, Submandibular glands, International consensus diagnostic criteria, Sialadenitis

Core tip: We previously reported that multiple hypoechoic lesions in submandibular glands (SGs) were a specific marker of autoimmune pancreatitis (AIP). In this study, we aimed to clarify the significance of hypoechoic lesions in SGs by ultrasonography in AIP diagnosis using the international consensus diagnostic criteria (ICDC). Ultrasonographic evidence of hypoechoic lesions in SGs improved the definitive diagnosis of sialadenitis and type 1 AIP by the ICDC criteria in 11 (30%) and 2 (5.4%) cases, respectively. SG ultrasonography to detect multiple hypoechoic lesions might be useful for type 1 AIP diagnosis by improving diagnostic accuracy together with the ICDC sialadenitis criteria.