Diagnostic accuracy of salivary gland ultrasonography with different scoring systems in Sjögren’s syndrome: a systematic review and meta-analysis

Zhou, Mingzhu; Shuju, Song; Wu, Shanshan; Duan, Ting; Chen, Letian; Ye, Jingyi; Xiao, Jun

doi:10.1038/s41598-018-35288-5

Cited by 29 publications

(19 citation statements)

References 28 publications

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“…Zhou et al realised a meta-analysis to evaluate the diagnostic accuracy of SGUS and observed a sensitivity of 75% and specificity of 93% for the diagnosis of SS. 14 Nevertheless, they pulled studies with different scoring systems. Recently, Mossel et al have shown that a combination of parotid and submandibular gland US grading and a serological test for anti-SS antibodies can effectively predict the AECG, ACR or ACR/EULAR classification results of patients.…”

Section: Discussionmentioning

confidence: 99%

Normal salivary gland ultrasonography could rule out the diagnosis of Sjögren’s syndrome in anti-SSA-negative patients with sicca syndrome

et al. 2021

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ObjectiveTo evaluate the relevance of salivary gland ultrasound (SGUS) and its place in the diagnostic algorithm in patients referred with dry syndrome (DS) for a suspicion of Sjögren’s syndrome (SS).MethodsWe included all patients assessed at our dedicated DS clinic from June 2015 to September 2019 for which a SGUS has been carried out. Images were read blindly and the worst salivary gland was scored according to OMERACT classification. Clinical features, disease activity and treatments were collected.Results337 patients were seen from June 2015 to September 2019. 269 patients underwent SGUS. 77 patients were diagnosed with SS and 192 did not meet the ACR/EULAR criteria for SS: non-Sjögren’s DS (NSDS). Of these 192 patients, 60 had another possible cause of DS, and 132 patients were diagnosed with SAPS (sicca, asthenia, polyalgia syndrome).SGUS abnormalities were significantly higher in patients with SS versus NSDS: 51% vs 8% for a score ≥2 (p<0.0001), and 43% vs 3% for a score ≥3 (p<0.0001). SGUS score ≥2 had a specificity (Sp) of 91%, sensitivity (Se) of 57%, positive predictive value (PPV) of 72% and negative predictive value (NPV) of 82% for SS diagnosis. SGUS’s characteristics in SSA-negative patients were similar to the whole population (Se=42%, Sp=91%, PPV=42%, NPV=92%). The high specificity and NPV in this population could avoid labial salivary gland biopsy (LSGB) in SSA-negative patients with normal SGUS (186 patients, 69%).ConclusionSGUS is useful for SS diagnosis. If anti-SSA antibodies are negative and SGUS score <2, the diagnosis of SS is very improbable and LSGB could be avoided.

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Section: Discussionmentioning

confidence: 99%

Normal salivary gland ultrasonography could rule out the diagnosis of Sjögren’s syndrome in anti-SSA-negative patients with sicca syndrome

et al. 2021

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“…Mode-B ultrasound using a high frequency linear probe allows characterization of size, homogeneity, presence of hypo-/anechoic areas, hyperechoic bands and clearness of SG borders. These different items were included in several diagnostic scores [ 257 ]. The OMERACT group, in an attempt to standardize, developed in 2019 a semi-quantitative scoring (0–3) based on the presence of hypoechoic/anechoic zones within the parenchyma of the parotid and submandibular glands [ 258 ].…”

Section: Diagnosis Workupmentioning

confidence: 99%

Current State of Knowledge on Primary Sjögren’s Syndrome, an Autoimmune Exocrinopathy

Parisis

Chivasso

Perret

et al. 2020

JCM

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Primary Sjögren’s syndrome (pSS) is a chronic systemic autoimmune rheumatic disease characterized by lymphoplasmacytic infiltration of the salivary and lacrimal glands, whereby sicca syndrome and/or systemic manifestations are the clinical hallmarks, associated with a particular autoantibody profile. pSS is the most frequent connective tissue disease after rheumatoid arthritis, affecting 0.3–3% of the population. Women are more prone to develop pSS than men, with a sex ratio of 9:1. Considered in the past as innocent collateral passive victims of autoimmunity, the epithelial cells of the salivary glands are now known to play an active role in the pathogenesis of the disease. The aetiology of the “autoimmune epithelitis” still remains unknown, but certainly involves genetic, environmental and hormonal factors. Later during the disease evolution, the subsequent chronic activation of B cells can lead to the development of systemic manifestations or non-Hodgkin’s lymphoma. The aim of the present comprehensive review is to provide the current state of knowledge on pSS. The review addresses the clinical manifestations and complications of the disease, the diagnostic workup, the pathogenic mechanisms and the therapeutic approaches.

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“…A simple, semi-quantitative 0-3 SGUS scoring system was recently selected by a systematic review and meta-analysis as more appropriate for diagnostic purposes in terms of specificity and heterogeneity in pSS, with respect to the other scoring systems available (e.g., 0-16 and 0-48) (19). One of the aims of the work-package 7 (WP7) of the HarmonicSS project is to develop and improve the role of SGUS for pSS management.…”

Section: Salivary Gland Ultrasound Scoresmentioning

confidence: 99%

Salivary Gland Ultrasonography in Sjögren's Syndrome: A European Multicenter Reliability Exercise for the HarmonicSS Project

et al. 2020

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Objectives: Salivary gland ultrasonography (SGUS) is increasingly applied for the management of primary Sjögren's syndrome (pSS). This study aims to: (i) compare the reliability between two SGUS scores; (ii) test the reliability among sonographers with different levels of experience.Methods: In the reliability exercise, two four-grade semi-quantitative SGUS scoring systems, namely De Vita et al. and OMERACT, were tested. The sonographers involved in work-package 7 of the HarmonicSS project from nine countries in Europe were invited to participate. Different levels of sonographers were identified on the basis of their SGUS experience and of the knowledge of the tested scores. A dedicated atlas was used as support for SGUS scoring.Results: Twenty sonographers participated in the two rounds of the reliability exercise. The intra-rater reliability for both scores was almost perfect, with a Light's kappa of 0.86 for the De Vita et al. score and 0.87 for the OMERACT score. The inter-rater reliability for the De Vita et al. and the OMERACT score was substantial with Light's Kappa of 0.75 and 0.77, respectively. Furthermore, no significant difference was noticed among sonographers with different levels of experience.Conclusion: The two tested SGUS scores are reliable for the evaluation of major salivary glands in pSS, and even less-expert sonographers could be reliable if adequately instructed.

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Diagnostic accuracy of salivary gland ultrasonography with different scoring systems in Sjögren’s syndrome: a systematic review and meta-analysis

Cited by 29 publications

References 28 publications

Normal salivary gland ultrasonography could rule out the diagnosis of Sjögren’s syndrome in anti-SSA-negative patients with sicca syndrome

Normal salivary gland ultrasonography could rule out the diagnosis of Sjögren’s syndrome in anti-SSA-negative patients with sicca syndrome

Current State of Knowledge on Primary Sjögren’s Syndrome, an Autoimmune Exocrinopathy

Salivary Gland Ultrasonography in Sjögren's Syndrome: A European Multicenter Reliability Exercise for the HarmonicSS Project

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