The authors have nothing to acknowledge.

Todos os procedimentos foram revistos e aprovados pelo Institutional Review Board do Hospital da Universidade Nacional Chungnam. 1. Medição com ultra-sonografia <ol><li> Defina a postura do paciente. <ol><li> Coloque o braço do paciente em decúbito dorsal, com ambos os braços sobre a cama. </li></ol></li><li> Determinar os locais de medição no membro superior do paciente. <ol><li> Marcos, no ponto médio da dobra do pulso, o ponto médio entre o epicôndilos medial e lateral ao nível do cotovelo, e o sulco bicipital por uma caneta. </li><li> Usando uma caneta conectar diretamente estes três pontos por um governante. Marque as duas zonas-alvo na parte superior do braço e antebraço (Figura 1). <ol><li> Marque a parte proximal, 10 centímetros proximal ao ponto de cotovelo ao longo da linha entre o cotovelo eo sulco bicipital. </li><li> Marque a parte distal, 10 cm distais ao ponto de cotovelo ao longo da linha entre o cotovelo e punho. </li></ol></li></ol></li><li> Medir a espessura do tecido subcutâneo e o músculo do membro superior. O procedimento deve ser realizado por um perito sonographer. <ol><li> Ligue o sistema de ultra-som. Entre no modo 2D dos tecidos moles através do teclado. Definir a profundidade de 5 cm. <ol><li> Escolha o transdutor linear 14l5. </li><li> Aplicar gel suficiente para o transdutor de ultra-sons. Concentre-se no tecido subcutâneo. </li></ol></li><li> Coloque o transdutor de ultra-som perpendicularmente ao eixo ventral do membro superior. Use a visão de curto eixo. Capturar a imagem, onde a espessura do gel é de pelo menos 1 cm e o contorno do tecido mole não é distorcida. </li><li> Medem-se as espessuras do tecido muscular e subcutânea. <ol><li> Desenha uma linha seleccionando o calibrador no software através do teclado do sistema de ultra-sons </li><li> Medir a espessura do músculo, definida como a distância entre o ponto mais alto na fronteira do osso para o ponto mais altona porção limite da fáscia (Figura 2). </li><li> Medir a espessura do tecido subcutâneo, definida como a distância a partir da pele para o fáscia. </li></ol></li></ol></li></ol> 2. A aplicação clínica da ultra-sonografia para BCRL <ol><li> Medir a espessura do tecido subcutâneo e o músculo do membro superior na linha de base. <ol><li> Realizar as medições da linha de base na ordem mostrada na Etapa 1. </li></ol></li><li> Instrua o paciente para realizar uma série de DRP usando um 0,5 kg halteres 14. <ol><li> Dar ao paciente uma meia de compressão ou um curativo multicamadas para vestir. Escolher um 0,5 kg halteres. </li><li> Instrua o paciente a realizar os PRE na seguinte ordem: (1) haltere voar, (2) tríceps extensão, (3) um braço bent-over linha, (4) rosca direta, (5) raise lado haltere, e (6 ) levantar os braços para a frente (Figura 3). <ol><li> Instrua o paciente para completar a 6exercícios duas vezes por dia, de acordo com o seguinte calendário: 5 vezes cada um durante a semana 1 st, 10 vezes cada durante a semana 2 nd, 15 vezes cada durante a semana de 3 rd, 20 vezes cada durante a 4ª semana, e 25 vezes cada durante 5 semanas th -8 th (Figura 4). </li></ol></li></ol></li><li> Use ultra-sonografia para identificar os efeitos terapêuticos do PRE comparativamente com a terapia convencional. <ol><li> Medir a espessura do tecido subcutâneo e o músculo do membro superior a 4 e 8 semanas. Realizar as medições na ordem mostrada na Etapa 1. </li></ol></li><li> Calcula-se a espessura do tecido subcutâneo e muscular no início do estudo, e 4 semanas, 8 semanas. </li><li> Analisar os dados. <ol><li> Compare a diferença entre ambos os braços usando um teste t emparelhado. Comparar as mudanças no tecido subcutâneo e da espessura do músculo usando um com medidas repetidas ANOVA. </li></ol></li></ol>

<ol>
	<li>Lasinski, B. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complete+decongestive+therapy+for+treatment+of+lymphedema.">Complete decongestive therapy for treatment of lymphedema.</a> Seminars in Oncology Nursing. 29 (1), 20-27 (2013).</li><li>Clark, B., Sitzia, J., Harlow, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+and+risk+of+arm+oedema+following+treatment+for+breast+cancer:+a+three-year+follow-up+study.">Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study.</a> Q J Med. 98 (5), 343-348 (2005).</li><li>Hayes, S. C., Speck, R. M., Reimet, E., Stark, A., Schmitz, K. 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H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasonographic+Evaluation+of+Therapeutic+Effects+of+Complex+Decongestive+Therapy+in+Breast+Cancer-Related+Lymphedema.">Ultrasonographic Evaluation of Therapeutic Effects of Complex Decongestive Therapy in Breast Cancer-Related Lymphedema.</a> Ann Rehabil Med. 37 (5), 683-689 (2013).</li><li>DiSipio, T., Rye, S., Newman, B., Hayes, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+of+unilateral+arm+lymphoedema+after+breast.">Incidence of unilateral arm lymphoedema after breast.</a> Lancet Oncol. 14 (6), 500-515 (2013).</li><li>Stanton, A. 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A., Turner, E., Spry, N., Saunders, C., Zissiadis, Y., Newton, R. U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+it+safe+and+efficacious+for+women+with+lymphedema+secondary+to+breast+cancer+to+lift+heavy+weights+during+exercise:+a+randomised+controlled+trial.">Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift heavy weights during exercise: a randomised controlled trial.</a> J Cancer Surviv. 7 (3), 413-424 (2013).</li><li>Bok, S. K., Jeon, Y., Hwang, P. 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The authors have nothing to disclose.

As avaliações de BCRL pode ser realizada através de várias técnicas, incluindo circunferências de braço de medição de fita, medição de deslocamento de água, espectroscopia de bioimpedância, perometry (volúmetro optoeletrônicos), linfocintilografia, diagnóstico clínico, ou inchaço auto-relatos por parte do paciente. No entanto, não existem padrões para a medição do BCRL; o diagnóstico e a duração do tratamento pode ser determinada empiricamente em um número de maneiras, dependendo da clínica. <...

O linfedema é definido como uma condição de localizada rica em proteínas de retenção e tecido fluido inchaço causado por um 1,2 sistema linfático comprometida. Como linfedema progride, fibrócitos e / ou adipócitos proliferar nas áreas afectadas, levando a alterações na textura da pele e do tecido subcutâneo e um aumento da vulnerabilidade a infecções bacterianas e fúngicas 3,4. A observação destas mudanças em várias partes das extremidades podem elucidar melhor a gravidade e extensão do linfedema. O sistema linfático subfascial contribui para a gravidade do linfedema mais do que o sistema linfático epifascial. Uma pesquisa recente tem se concentrado principalmente no uso da ultra-sonografia no diagnóstico de linfedema 5,6. A US é um método relativamente barato para observar as características dos tecidos moles. Um estudo anterior relatou que linfedema pode ser confiavelmente diagnosticado com ultra-sonografia, comparando tele espessura da pele e tecido subcutâneo e também pela avaliação da conformidade do tecido subcutâneo em um ambiente clínico 7,8. Além disso, os ultra-sonografia é amplamente utilizado na prática clínica devido à sua fácil acessibilidade, a segurança da exposição à radiação, e inexpensiveness 5,6. Apesar destes benefícios, os estudos sobre a ultra-sonografia para o linfedema só foram focados no diagnóstico, não na avaliação de intervenção terapêutica. Portanto, o presente estudo teve como objetivo determinar não só a utilidade do ultrassom em elucidar os efeitos da PRE em BCRL, mas também se ultra-sonografia tem um significado clínico como um teste de acompanhamento para confirmar a eficácia do tratamento. Este estudo foi realizado para estabelecer o protocolo para ultra-sonografias realizadas para examinar linfedema.

<table><tbody><tr><td>ACUSON S2000</td><td>Siemens</td><td>10041461</td><td></td></tr><tr><td>Eco Gel 99</td><td>Seung Won Medical Corp.</td><td></td><td></td></tr></tbody></table>

ultrasonographic evaluation of breast cancer-related lymphedema

O linfedema é uma das complicações mais comuns após cirurgia de câncer de mama. Existem muitas ferramentas de diagnóstico para o linfedema, mas nenhum método padrão ainda existe. Resistência progressiva Exercício (PRE) é esperado para melhorar linfedema, sem inchaço adicional. Este estudo mostrou que os efeitos terapêuticos do PRE em linfedema usando ultra-sonografia para medir a alteração na espessura do tecido muscular e subcutânea. A espessura do tecido subcutâneo diminuiu mais no grupo pré que no grupo não-PRE. A ultra-sonografia é amplamente utilizado em muitas clínicas por causa de sua fácil acessibilidade, segurança e inexpensiveness. O ultra-som é uma das melhores ferramentas para diagnosticar e determinar a eficácia do tratamento em linfedema relacionados com o cancro da mama (BCRL).

Este estudo incluiu 32 pacientes com diagnóstico de BCRL. A espessura do músculo e tecido subcutâneo e das circunferências dos membros superiores proximal e distal foram medidos no início do estudo, 4 semanas e 8 semanas após o PRE. Examinadores medida da circunferência do membro superior com uma fita métrica, e, em seguida, a espessura do músculo e tecido subcutâneo foram medidos por ultrassonografia. Os pacientes foram divididos aleatoriamente num grupo pré e um grupo não-P...

Watch this Scientific Journal Video about Ultrasonographic Evaluation of Breast Cancer-related Lymphedema at JoVE.com

Ultrasonographic Evaluation of Breast Cancer-related Lymphedema

Esta ultra-sonografia estudo utilizou para o diagnóstico e exames de seguimento para confirmar a eficácia do tratamento de resistência progressiva Exercício (PRE) em linfedema relacionados com o cancro da mama (BCRL). A ultra-sonografia pode ser aplicada de forma eficaz para garantir o diagnóstico e tratamento do linfedema.

Ultrassonográfico Avaliação do linfedema relacionados com o cancro da mama

Lymphedema is one of the most common complications after breast cancer surgery. There are many diagnostic tools for lymphedema, but no standard method yet ...

ultrasonographic-evaluation-of-breast-cancer-related-lymphedema

Research

JoVE Journal

Cancer Research

9.8K visualizações.  Chungnam National University Hospital (CNUH).  Esta ultra-sonografia estudo utilizou para o diagnóstico e exames de seguimento para confirmar a eficácia do tratamento de resistência progressiva Exercício (PRE) em linfedema relacionados com o cancro da mama (BCRL). A ultra-sonografia pode ser aplicada de forma eficaz para garantir o diagnóstico e tratamento do linfedema. 

Vídeo: Ultrasonographic Evaluation of Breast Cancer-related Lymphedema

Non-invasive Optical Imaging of the Lymphatic Vasculature of a Mouse

The lymphatic vascular system is an important component of the circulatory system that maintains fluid homeostasis, provides immune surveillance, and mediates fat absorption in the gut. Yet despite its critical function, there is comparatively little understanding of how the lymphatic system adapts to serve these functions in health and disease1. Recently, we have demonstrated the ability to dynamically image lymphatic architecture and lymph "pumping" action in normal human subjects as well as in persons suffering lymphatic dysfunction using trace administration of a near-infrared fluorescent (NIRF) dye and a custom, Gen III-intensified imaging system2-4. NIRF imaging showed dramatic changes in lymphatic architecture and function with human disease. It remains unclear how these changes occur and new animal models are being developed to elucidate their genetic and molecular basis. In this protocol, we present NIRF lymphatic, small animal imaging5,6 using indocyanine green (ICG), a dye that has been used for 50 years in humans7, and a NIRF dye-labeled cyclic albumin binding domain (cABD-IRDye800) peptide that preferentially binds mouse and human albumin8. Approximately 5.5 times brighter than ICG, cABD-IRDye800 has a similar lymphatic clearance profile and can be injected in smaller doses than ICG to achieve sufficient NIRF signals for imaging8. Because both cABD-IRDye800 and ICG bind to albumin in the interstitial space8, they both may depict active protein transport into and within the lymphatics. Intradermal (ID) injections (5-50 &mu;l) of ICG (645 &mu;M) or cABD-IRDye800 (200 &mu;M) in saline are administered to the dorsal aspect of each hind paw and/or the left and right side of the base of the tail of an isoflurane-anesthetized mouse. The resulting dye concentration in the animal is 83-1,250 &mu;g/kg for ICG or 113-1,700 &mu;g/kg for cABD-IRDye800. Immediately following injections, functional lymphatic imaging is conducted for up to 1 hr using a customized, small animal NIRF imaging system. Whole animal spatial resolution can depict fluorescent lymphatic vessels of 100 microns or less, and images of structures up to 3 cm in depth can be acquired9. Images are acquired using V++ software and analyzed using ImageJ or MATLAB software. During analysis, consecutive regions of interest (ROIs) encompassing the entire vessel diameter are drawn along a given lymph vessel. The dimensions for each ROI are kept constant for a given vessel and NIRF intensity is measured for each ROI to quantitatively assess "packets" of lymph moving through vessels.

Recently developed imaging techniques using near-infrared fluorescence (NIRF) may help elucidate the role the lymphatic system plays in cancer metastasis, immune response, wound repair, and other lymphatic-associated diseases.

Não-invasiva de Imagem Óptico da vasculatura linfática de um rato

The lymphatic  vascular system is an important component of the circulatory system that  maintains fluid homeostasis, provides immune surveillance, and ...

Imunologia e Infecção

Analysis of Lymph Node Volume by Ultra-High-Frequency Ultrasound Imaging in the Braf/Pten Genetically Engineered Mouse Model of Melanoma

Tyr::CreER+,BrafCA/+,Ptenlox/lox&#160;genetically engineered mice (Braf/Pten mice) are widely used as an in vivo model of metastatic melanoma. Once a primary tumor has been induced by tamoxifen treatment, an increase in metastatic burden is observed within 4-6 weeks after induction. This paper shows how Ultra-High-Frequency UltraSound (UHFUS) imaging can be exploited to monitor the increase in metastatic involvement of the inguinal lymph nodes by measuring the increase in their volume.
The UHFUS system is used to scan anesthetized mice with a UHFUS linear probe (22-55 MHz, axial resolution 40 &#181;m). B-mode images from the inguinal lymph nodes (both left and right sides) are acquired in a short-axis view, positioning the animals in dorsal recumbency. Ultrasound records are acquired using a 44 &#181;m step size on a motorized mechanical arm. Afterward, two-dimensional (2D) B-mode acquisitions are imported into the software platform for ultrasound image post-processing, and inguinal lymph nodes are identified and segmented semi-automatically in the acquired cross-sectional 2D images. Finally, a total reconstruction of the three-dimensional (3D) volume is automatically obtained along with the rendering of the lymph node volume, which is also expressed as an absolute measurement.
This non-invasive in vivo technique is very well tolerated and allows the scheduling of multiple imaging sessions on the same experimental animal over 2 weeks. It is, therefore, ideal to assess the impact of pharmacological treatment on metastatic disease.

Melanoma is a very aggressive disease that quickly spreads to other organs. This protocol describes the application of ultra-high-frequency ultrasound imaging, coupled with 3D rendering, to monitor the volume of the inguinal lymph nodes in the Braf/Pten mouse model of metastatic melanoma.

Análise do volume do nódulo linfático por ultra-alta frequência ultrassom no modelo de camundongos geneticamente modificado braf/pten de melanoma

Tyr::CreER+,BrafCA/+,Ptenlox/lox&#160;genetically engineered mice (Braf/Pten mice) are widely used as an in vivo model of metastatic melanoma. Once a ...

Pesquisa do câncer

Tracking the Mammary Architectural Features and Detecting Breast Cancer with Magnetic Resonance Diffusion Tensor Imaging

Breast cancer is the most common cause of cancer among women worldwide. Early detection of breast cancer has a critical role in improving the quality of life and survival of breast cancer patients. In this paper a new approach for the detection of breast cancer is described, based on tracking the mammary architectural elements using diffusion tensor imaging (DTI). 
The paper focuses on the scanning protocols and image processing algorithms and software that were designed to fit the diffusion properties of the mammary fibroglandular tissue and its changes during malignant transformation. The final output yields pixel by pixel vector maps that track the architecture of the entire mammary ductal glandular trees and parametric maps of the diffusion tensor coefficients and anisotropy indices. 
The efficiency of the method to detect breast cancer was tested by scanning women volunteers including 68 patients with breast cancer confirmed by histopathology findings. Regions with cancer cells exhibited a marked reduction in the diffusion coefficients and in the maximal anisotropy index as compared to the normal breast tissue, providing an intrinsic contrast for delineating the boundaries of malignant growth. Overall, the sensitivity of the DTI parameters to detect breast cancer was found to be high, particularly in dense breasts, and comparable to the current standard breast MRI method that requires injection of a contrast agent. Thus, this method offers a completely non-invasive, safe and sensitive tool for breast cancer detection.

We describe how to obtain parametric and vector maps of the diffusion tensor of the breast using magnetic resonance imaging. The protocol and final output following imaging processing are tailored for tracking breast architectural features and detecting breast malignancy.

Acompanhando as mamárias elementos arquitectónicos e detecção do câncer de mama com Ressonância Magnética Tensor Difusão de imagens

Breast cancer is the most common cause of cancer among women worldwide. Early detection of breast cancer has a critical role in improving the quality of ...

Medicina

High-frequency Ultrasound Imaging of Mouse Cervical Lymph Nodes

High-frequency ultrasound (HFUS) is widely employed as a non-invasive method for imaging internal anatomic structures in experimental small animal systems. HFUS has the ability to detect structures as small as 30 &#181;m, a property that has been utilized for visualizing superficial lymph nodes in rodents in brightness (B)-mode. Combining power Doppler with B-mode imaging allows for measuring circulatory blood flow within lymph nodes and other organs. While HFUS has been utilized for lymph node imaging in a number of mouse&#160; model systems, a detailed protocol describing HFUS imaging and characterization of the cervical lymph nodes in mice has not been reported. Here, we show that HFUS can be adapted to detect and characterize cervical lymph nodes in mice. Combined B-mode and power Doppler imaging can be used to detect increases in blood flow in immunologically-enlarged cervical nodes. We also describe the use of B-mode imaging to conduct fine needle biopsies of cervical lymph nodes to retrieve lymph tissue for histological&#160; analysis. Finally, software-aided steps are described to calculate changes in lymph node volume and to visualize changes in lymph node morphology following image reconstruction. The ability to visually monitor changes in cervical lymph node biology over time provides a simple and powerful technique for the non-invasive monitoring of cervical lymph node alterations in preclinical mouse models of oral cavity disease.

This protocol describes the application of high-frequency ultrasound (HFUS) for imaging mouse cervical lymph nodes. This technique optimizes visualization and quantification of cervical lymph node morphology, volume and blood flow. Image-guided biopsy of cervical lymph nodes and processing of lymph tissue for histological evaluation is also demonstrated.

De alta frequência Ecografia de mouse linfonodos cervicais

High-frequency ultrasound (HFUS) is widely employed as a non-invasive method for imaging internal anatomic structures in experimental small animal ...

Integrating Augmented Reality Tools in Breast Cancer Related Lymphedema Prognostication and Diagnosis

Breast cancer related lymphedema (BCRL) is a detrimental condition characterized by fluid accumulation in the upper limb in breast cancer patients subjected to axillary surgery and/or radiations. Its etiology is multifactorial and include also tumor-specific pathological features, such as lymphovascular invasion (LVI) and extranodal extension (ENE). To date, no widely employed guidelines for the early diagnosis of BCRL are available. Here, we illustrate a protocol for a digitally assisted BCRL assessment using a 3D laser scanner (3DLS) and a tablet computer. It has been specifically optimized in a discovery cohort of high-risk breast cancer patients. This study provides a proof-of-principle that augmented reality tools, such as 3DLS, can be incorporated into the clinical workup of BCRL to allow for a precise, reproducible, reliable, and cheap diagnosis.

Breast cancer related lymphedema is frequent in breast cancer survivors, but there are not widely employed guidelines for its diagnosis and quantification. Here, we introduce a reliable and cost-effective protocol to define, quantify, and compare upper limb volume in breast cancer patients.

Integrando ferramentas de realidade aumentada no prognóstico e diagnóstico de linfofedema relacionadaao câncer de mama

Breast cancer related lymphedema (BCRL) is a detrimental condition characterized by fluid accumulation in the upper limb in breast cancer patients ...

A Revised Method for Inducing Secondary Lymphedema in the Hindlimb of Mice

Animal models are of paramount importance in the research of lymphedema in order to understand the pathophysiology of the disease but also to explore potential treatment options. This mouse model allows researchers to induce significant lymphedema lasting at least 8 weeks. Lymphedema is induced using a combination of fractioned radiotherapy and surgical ablation of lymphatics. This model requires that the mice get a dose of 10 Gray (Gy) radiation before and after surgery. The surgical part of the model involves ligation of three lymph vessels and extraction of two lymph nodes from the mouse hindlimb. Having access to microsurgical tools and a microscope is essential, due to the small anatomical structures of mice. The advantage of this model is that it results in statistically significant lymphedema, which provides a good basis for evaluating different treatment options. It is also a great and easily available option for microsurgical training. The limitation of this model is that the procedure can be time consuming, especially if not practiced in advance. The model results in objectively quantifiable lymphedema in mice, without causing severe morbidity and has been tested in three separate projects.

This animal model enables researchers to induce statistically significant secondary lymphedema in the hindlimb of mice, lasting at least 8 weeks. The model can be used to study the pathophysiology of lymphedema and to investigate novel treatment options.

Um método revisado para induzir o linfedema secundário no hindlimb dos ratos

Animal models are of paramount importance in the research of lymphedema in order to understand the pathophysiology of the disease but also to explore ...

A Murine Tail Lymphedema Model

Lymphedema is extremity swelling caused by lymphatic dysfunction. The affected limb enlarges because of accumulation of fluid, adipose, and fibrosis. There is no cure for this disease. A mouse tail model that uses a focal full thickness skin excision near the base of the tail, resulting in tail swelling, has been used to study lymphedema. However, this model may result in vascular comprise and consequent tail necrosis and early tail swelling resolution, limiting its clinical translatability. The chronic murine tail lymphedema model induces sustained lymphedema over 15 weeks and a reliable perfusion to the tail. Enhancements of the traditional murine tail lymphedema model include 1) precise full thickness excision and lymphatic clipping using a surgical microscope, 2) confirmation of post-operative arterial and venous perfusion using high resolution laser speckle, and 3) functional assessment using indocyanine green near infrared laser lymphangiography. We also use tissue nanotransfection technology (TNT) for novel non-viral, transcutaneous, focal delivery of genetic cargo to the mouse tail vasculature.

Lymphedema is extremity swelling caused by lymphatic dysfunction. We describe a chronic murine tail model of lymphedema and the novel use of tissue nanotransfection technology (TNT) for genetic cargo delivery to the tail.

Um modelo de linfedema de cauda murina

Lymphedema is extremity swelling caused by lymphatic dysfunction. The affected limb enlarges because of accumulation of fluid, adipose, and fibrosis. ...

Técnica para exame de ultrassom de glândulas salivares da síndrome de Sjögren

Ultrasonographic Evaluation of Salivary Glands for Sjogren's Syndrome: Diagnostic and Monitoring Insights

Sjogren's syndrome (SS) is a chronic autoimmune condition commonly affecting the exocrine glands, causing oral or ocular dryness and extraglandular manifestations including arthralgia, cytopenia, and lymphoma. The presence of autoantibodies against SSA/Ro, labial salivary gland biopsy, ocular staining, Schirmer's test, or salivary flow assessment are included in the current classification criteria of SS. However, the availability and invasiveness of these procedures limit their widespread use in clinical settings. Salivary gland ultrasonography (SGUS) is a non-invasive imaging modality for the evaluation of the salivary gland parenchyma and is increasingly utilized to aid diagnosis and monitoring in SS. 
This article presents the protocol of SGUS for image acquisition at the parotid and submandibular glands. The objective is to present a standardized, reproducible, and practical approach to diagnostic SGUS for SS in daily clinical settings. Major salivary glands are scanned in a stepwise approach, beginning at the angle of the mandible for the superficial lobe of the parotid gland, followed by the deep lobe below the ramus of the mandible. Submandibular areas are then scanned for the submandibular glands. The steps in obtaining salivary gland images at each anatomical site are explained in the accompanying video. The echogenicity and echotexture at the thyroid gland are taken as a reference. The homogeneity, the presence and distribution of hypoechoic areas within the glands, and the border of the salivary glands are examined. The sizes and features of intra-/peri-glandular lymph nodes are recorded. The most distinctive sonographic feature in SS is glandular heterogeneity with the presence of hypoechoic/hyperechoic areas within the glands. 
In summary, while SGUS cannot diagnose SS on its own, it can supplement the current classification criteria of SS and guide the clinical decision for salivary gland biopsy to support the diagnosis of SS in patients with sicca syndrome or suspicious systemic features, combined with autoantibody testing.

Autor em destaque: um foco no protocolo padronizado de ultrassom da glândula salivar na pesquisa de doenças do tecido conjuntivo

Salivary gland ultrasonography is a promising tool for the diagnosis and evaluation of disease activity and complications in Sjogren's syndrome (SS). The scanning technique for salivary gland ultrasound examination relevant to SS is described in the article.

Avaliação ultrassonográfica de glândulas salivares para síndrome de Sjögren: insights diagnósticos e de monitoramento

Sjogren's syndrome (SS) is a chronic autoimmune condition commonly affecting the exocrine glands, causing oral or ocular dryness and extraglandular ...

Ultrassonográfico Avaliação do linfedema relacionados com o cancro da mama

Resumo

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Avaliação ultrassonográfica de glândulas salivares para síndrome de Sjögren: insights diagnósticos e de monitoramento