Salivary Gland Ultrasonography In Primary Sjögren's Syndrome From Diagnosis To Clinical Stratification: A Multicentre Study

Abstract Background: To determine the diagnostic accuracy of major salivary gland ultrasonography (SGUS) in primary Sjögren’s syndrome (pSS) using the novel Outcome Measures in Rheumatology Clinical Trials (OMERACT) scoring system in a large-scale multicentre study.Methods: SGUS was conducted for 246 pSS patients, 140 control subjects with conditions other than SS and 27 healthy control subjects. The echostructure features from the parotid and submandibular glands on both sides were graded using the novel OMERACT scoring system. Receiver operating characteristic curves were used to describe the diagnostic accuracy of the scoring system for pSS. The associations between the SGUS and disease characteristics were analysed to evaluate the clinical value of SGUS for pSS.Results: The US scores in the pSS group were significantly higher than those in the non-pSS group (P < 0.001). The level of diagnostic accuracy was comparable with the scores of all four glands (AUC=0.908) when only the parotid and submandibular glands on either side were scored (AUC=0.910, 0.904, respectively). The optimal cut-off value for the parotid and submandibular glands was 4, with maximal sensitivity (75.6% and 77.2%, respectively) and specificity (91.6% and 92.2%, respectively). The pSS patients with positive SGUS results presented a longer disease duration, parotid enlargement, dental loss and higher levels of serological markers, such as anti-SSA, anti-SSB, positive RF, IgG and γ-globulin%. Conclusions: SGUS with the OMERACT scoring system yields high sensitivity and specificity, demonstrating high diagnostic feasibility for pSS. The SGUS may have implications for deciding disease severity and treatment efficacy.

Download Full-text

Salivary gland ultrasonography in primary Sjögren’s syndrome from diagnosis to clinical stratification: a multicentre study

Arthritis Research & Therapy ◽

10.1186/s13075-021-02689-3 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Xia Zhang ◽

Ruiling Feng ◽

Jinxia Zhao ◽

Yu Wang ◽

Juan He ◽

...

Keyword(s):

Salivary Gland ◽

Multicentre Study ◽

Diagnostic Accuracy ◽

Scoring System ◽

Primary Sjögren’S Syndrome ◽

The Novel ◽

Primary Sjogren’S Syndrome ◽

Primary Sjögren's Syndrome ◽

Submandibular Glands ◽

Control Subjects

Abstract Background To determine the diagnostic accuracy of major salivary gland ultrasonography (SGUS) in primary Sjögren’s syndrome (pSS) using the novel Outcome Measures in Rheumatology Clinical Trials (OMERACT) scoring system in a large-scale multicentre study. Methods SGUS was conducted for 246 pSS patients, 140 control subjects with conditions other than SS and 27 healthy control subjects. The echostructure features from the parotid and submandibular glands on both sides were graded using the novel OMERACT scoring system. Receiver operating characteristic curves were used to describe the diagnostic accuracy of the scoring system for pSS. The associations between the SGUS and disease characteristics were analysed to evaluate the clinical value of SGUS for pSS. Results The US scores in the pSS group were significantly higher than those in the non-pSS group (p < 0.001). The level of diagnostic accuracy was comparable with the scores of all four glands (AUC=0.908) when only the parotid and submandibular glands on either side were scored (AUC=0.910, 0.904, respectively). The optimal cut-off value for the left (right) parotid gland and the left (right) submandibular gland was 4, with maximal sensitivity (75.6% and 77.2%, respectively) and specificity (91.6% and 92.2%, respectively). The pSS patients with positive SGUS results presented a longer disease duration, parotid enlargement, dental loss and higher levels of serological markers, such as anti-SSA, anti-SSB, positive RF, IgG and γ-globulin%. Conclusions SGUS with the OMERACT scoring system yields high sensitivity and specificity, demonstrating high diagnostic feasibility for pSS. The SGUS may have implications for deciding disease severity and treatment efficacy.

Download Full-text

FRI0150 USEFULNESS OF SALIVARY GLAND ULTRASONOGRAPHY IN THE ASSESSMENT OF SALIVARY GLAND ACTIVITY AND DAMAGE IN PRIMARY SJÖGREN’S SYNDROME: A SINGLE CENTER EXPERIENCE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4594 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 659.1-659

Author(s):

F. Ferro ◽

G. Governato ◽

V. Donati ◽

G. Fulvio ◽

S. Fonzetti ◽

...

Keyword(s):

Salivary Gland ◽

Lymph Nodes ◽

Disease Activity ◽

Primary Sjögren’S Syndrome ◽

Newly Diagnosed ◽

Primary Sjogren’S Syndrome ◽

Primary Sjögren's Syndrome ◽

Submandibular Glands ◽

Salivary Gland Disease

Background:Salivary gland ultrasonography (SGUS) has an emerging role in the diagnosis of primary Sjögren’s syndrome (pSS); however, it is still an open issue whether distinct sonographic abnormalities may indicate reversible glandular activity or irreversible disease-induced damage.Objectives:to assess the association between SGUS abnormalities, salivary gland disease activity and loss of function in pSS patients over a long-term follow-up.Methods:Patients with pSS fulfilling the AECG 2002 criteria were included in this observational study. Both parotid and submandibular glands were examined at the time of the study inclusion and during the follow-up. SGUS findings (i.e gland size, echogenicity, homogeneity, hyperechoic bands, number and location of the hypoechoic/anechoic areas, number of lymph nodes, calcification, posterior border visibility) were defined according to previous studies and monitored over the time. Patients demographics, clinical, histological and laboratory data were routinely collected. ESSDAI and ESSPRI were used to asses disease activity and PROs.Results:We included 419 (402 F:17 M) pSS patients: 206/419 at the diagnosis and 213/419 with a median disease duration of 7 (IQR 4-11) years. SGUS examination was repeated in 81/206 and in 108/213 patients, after a median follow-up of 30 (IQR 12-42) months, respectively. Noteworthy, 18/419 pSS patients were treated with rituximab (RTX) during the study period. The overall SGUS score correlated directly with the minor salivary focus score (r=0.366, p=0.000) and with the ESSDAI (r=0.482, p=0.000); the parotid inhomogeneity score correlated directly with the glandular domain of the ESSDAI (r=0.530, p=0.000). The unstimulated salivary flow rate (USFR) correlated inversely with the overall SGUS score (r=-257, p=0.000) and with the presence of hyperechoic bands in both the parotid (r=-210, p=0.03) and the submandibular glands (r=-316, p=0.000). When compared to patients with an established pSS, newly diagnosed patients presented less frequently a gross inhomogeneity in their parotid glands (30/206, 14.6% vs 53/213, 24.9%, p=0.01) and less hyperechoic bands in both their parotid (33/206, 16% vs 61/213, 29%, p=0.001) and submandibular glands (53/206, 26% vs 110/213, 52%, p=0.001). However, over a median 30 month-follow-up we did not observe any significant change neither in the number of hypo-anechoic areas nor in the inhomogeneity score in both newly diagnosed patients and in those with an established disease. Out of the 18 pSS patients treated with RTX, 14 (78%) presented at the baseline a moderate to gross inhomogeneity in their glands: no changes in the number of hypo-anechoic areas were observed also in these patients with the exception of a variation in the number of intra-parotid lymph nodes.Conclusion:SGUS abnormalities appeared to be associated to both salivary gland disease activity and damage. Namely, the presence of hyperechoic bands significantly correlated with salivary loss function. Diffuse-scattered hypoechoic areas did not change over a median 30-month followed-up indicating that additional studies are required to better elucidate the correlation between SGUS abnormalities and the corresponding histopathologic lesions.Disclosure of Interests:Francesco Ferro: None declared, Gianmaria Governato: None declared, Valentina Donati: None declared, Giovanni Fulvio: None declared, Silvia Fonzetti: None declared, Elena Elefante: None declared, Nicoletta Luciano Speakers bureau: Paid as speaker for Eli Lilly, Sanofi, Marta Mosca: None declared, Antonella Cecchettini: None declared, Chiara Baldini: None declared

Download Full-text

Scoring hypoechogenic areas in one parotid and one submandibular gland increases feasibility of ultrasound in primary Sjögren’s syndrome

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-211992 ◽

2017 ◽

Vol 77 (4) ◽

pp. 556-562 ◽

Cited By ~ 13

Author(s):

Esther Mossel ◽

Suzanne Arends ◽

Jolien F van Nimwegen ◽

Konstantina Delli ◽

Alja J Stel ◽

...

Keyword(s):

Multivariate Analysis ◽

Salivary Glands ◽

Submandibular Gland ◽

Scoring System ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Primary Sjögren’S Syndrome ◽

Primary Sjogren’S Syndrome ◽

Primary Sjögren's Syndrome ◽

Submandibular Glands

ObjectiveTo assess whether ultrasonographic scoring of (i) both parotid and submandibular salivary glands and (ii) all individual components of the Hocevar scoring system, is needed for classifying patients as primary Sjögren’s syndrome (pSS).MethodsUltrasound examination of the major salivary glands (sUS) was performed in 204 consecutive patients clinically suspected (n=171) or diagnosed (n=33) with pSS.Parenchymal echogenicity, homogeneity, hypoechogenic areas, hyperechogenic reflections and salivary gland posterior border were scored in left and right parotid and submandibular glands. Logistic regression analyses were performed to assess which glands and sUS components contributed significantly to classification as pSS or non-pSS according to the 2016 American College of Rheumatology-European League Against Rheumatism (ACR-EULAR) criteria.Results116 (57%) patients were classified as pSS, the remaining as non-pSS. Instead of scoring both sides (area under the curve; AUC=0.856, Nagelkerke R2=0.526), multivariate analysis showed that sUS scoring of only right (AUC=0.850; R2=0.518) or left (AUC=0.852; R2=0.511) parotid and submandibular glands is sufficient to predict ACR-EULAR classification. Moreover, all individual components of the Hocevar scoring system significantly predicted classification. Multivariate analysis showed that parenchymal echogenicity and hypoechogenic areas contributed independently to ACR-EULAR classification (AUC=0.857; R2=0.539). Scoring these components in one parotid and one submandibular gland highly predicted ACR-EULAR classification (AUC=0.855; R2=0.539). Scoring only hypoechogenic areas on one side showed almost similar results (AUC=0.846; R2=0.498).ConclusionsUS examination of parotid and submandibular glands on one side is sufficient to predict classification of patients according to the ACR-EULAR criteria. To further increase feasibility of sUS in outpatient clinics worldwide, only hypoechogenic areas can be scored.

Download Full-text

Diagnostic Value of Salivary Gland Ultrasonographic Scoring System in Primary Sjögren’s Syndrome: A Comparison with Scintigraphy and Biopsy

The Journal of Rheumatology ◽

10.3899/jrheum.081267 ◽

2009 ◽

Vol 36 (7) ◽

pp. 1495-1500 ◽

Cited By ~ 68

Author(s):

VERA D. MILIC ◽

RADMILA R. PETROVIC ◽

IVAN V. BORICIC ◽

JELENA MARINKOVIC-ERIC ◽

GORAN L. RADUNOVIC ◽

...

Keyword(s):

Salivary Gland ◽

Salivary Glands ◽

Scoring System ◽

Sjogren’S Syndrome ◽

Diagnostic Value ◽

Sjogren's Syndrome ◽

Primary Sjögren’S Syndrome ◽

Primary Sjogren’S Syndrome ◽

Primary Sjögren's Syndrome ◽

Salivary Gland Biopsy

Objective.To compare an ultrasonographic (US) scoring system of salivary glands with scintigraphy and salivary gland biopsy, in order to evaluate its diagnostic value in primary Sjögren’s syndrome (SS).Methods.In 135 patients with suspected SS, the grades of 5 US measures of both parotid and submandibular salivary glands were scored (0–48 scale). Diagnosis of primary SS was established following the American-European Consensus Group criteria of 2002. The patients’ total scintigraphic score (0–12 scale) was determined and the histopathological changes of minor salivary glands graded. Area under the receiver-operating characteristic (ROC) curve was employed to evaluate the diagnostic value of the US scoring system.Results.Primary SS was diagnosed in 107 (79.2%) patients and the remaining 28 subjects (20.8%) constituted the control group. US changes of salivary glands were established in 98/107 patients with SS and in 14/28 controls. Mean US score was 26 in SS patients and 6 in controls. Through ROC curves, US arose as the best performer (0.95 ± 0.01), followed by scintigraphy (0.86 ± 0.31). Setting the cutoff score for US at 19 resulted in the best ratio of specificity (90.8%) to sensitivity (87.1%), while setting the cutoff scintigraphic score at 6 resulted in specificity of 86.1% and sensitivity of 67.1%. Among 70 patients with US score ≥ 19, a scintigraphic score > 6 was recorded in 54/70 (77.1%) and positive biopsy findings in 62/70 (88.5%) patients.Conclusion.We show high diagnostic accuracy of a novel US scoring system of salivary glands (0–48) in patients with primary SS comparable to invasive methods, i.e., scintigraphy and salivary gland biopsy.

Download Full-text