Diagnostic Performances of Ultrasound Evaluation of Major Salivary Glands According to the 2019 Outcome Measures in Rheumatology Ultrasound Scoring System

Abstract

Objective. To evaluate the diagnostic performance of ultrasound examination of the major salivary glands (US-SG) according to the 2019 OMERACT US scoring system for Sjogren's syndrome (SS).Methods. This was a retrospective study based on a multicentric cohort of SS/sicca syndrome. ACR/EULAR 2016 (≥ 4 without OSS), AECG 2002 and clinician experts were considered as reference standards for SSdiagnosis. An OMERACT score ≥ 2 according to 2 independent readers defined the diagnosis of SS based on US-SG assessment. Diagnostic performances and Inter-observer reproducibility of US-SG were assessed.Results. Forty-two patients fulfilling the ACR/EULAR 2016 criteria for SS were compared to 30 controls with sicca syndrome. Twenty-five patients were diagnosed with SS according to US-SG evaluation, they were more frequently included in the SS group (52.5%) than in controls (10.0%) (p < 0.001). US-SG showed AUC of 0.751 (0.621-0.882) for the diagnosis of SS (ACR/EULAR 2016 classification). The inclusion of USSG in the ACR/EULAR 2016 classification improved Se (91.5% vs 89.4%) with limited decrease of Sp (96.0% vs 100%) and with an AUC of 0.975 (0.945-1.00). Similar results were observed when USSG was included in the AECG 2002 classification. Inter-observer reproducibility of the 2019 OMERACT US scoring ≥ 2 for SS diagnosis was good (k =0.73 (0.64-0.81)). Histological lymphocyte infiltration of the minor salivary glands was associated with the OMERACT grading of US-SG. Conclusion.This study confirms the good specificity of the 2019 OMERACT US classification of US-SG for the diagnosis of SS and its feasibility in daily practice.

Impact of age on the diagnostic performance of unstimulated salivary flow rates and salivary gland ultrasound for primary Sjögren's syndrome

“…Owing to the lack of imaging methods to visualize the major salivary glands, many researchers are interested in incorporating SGUS into the current ACR/EULAR criteria ( 4 , 22 , 24 ). A recent study demonstrated that the combination of positive SGUS and the presence of anti-SSA/Ro antibodies highly predicted the pSS classification according to the ACR/EULAR classification criteria ( 25 ).…”

“…In case of disagreement between the rheumatologists, the results obtained by the more experienced rheumatologist were used to analyse the diagnostic performance. A score ≥ 2 for the most affected salivary gland defined SGUS as compatible with a pSS diagnosis ( 4 ). A total of 0–12 total SGUS scores were calculated as the sum of the four glands.…”

“…Scintigraphy and sialography data were omitted from the 2016 ACR/EULAR classification criteria. To overcome the limitations of the absent salivary gland imaging technique in these classification criteria, incorporating salivary gland ultrasound (SGUS) in the ACR/EULAR criteria has been reported to improve diagnostic performance ( 4 – 6 ).…”

Value of magnetic resonance imaging and sialography of the parotid gland for diagnosis of primary Sjögren syndrome

“…4,5 SGUS is economical and has become the most widely recognized auxiliary diagnostic tool. [6][7][8] However, it provides low-resolution images, and there are systematic training and high technical requirements for operators. In reality, there is a shortage of such specialists in clinical practice.…”

“…A variety of imaging techniques, such as salivary gland ultrasound (SGUS), magnetic resonance imaging (MRI), magnetic resonance parotid sialography (MRS), X‐ray contrast, are increasingly used to diagnose and monitor the progression of pSS 4,5 . SGUS is economical and has become the most widely recognized auxiliary diagnostic tool 6–8 . However, it provides low‐resolution images, and there are systematic training and high technical requirements for operators.…”