Objectives This study aims to describe the sonographic abnormalities of the major salivary glands in patients evaluated for sicca syndrome.
Methods 110 consecutive patients with sicca syndrome, 104 females and 6 males, aged between 23 and 81 years (mean age 50,9), were studied for suspected diagnosis of Sjogren’s Syndrome (SS). The classification of patients with SS was made according to the American-European Consensus Group criteria. Minor salivary gland biopsy was performed in accordance with the procedure proposed by Daniels et al and the histopathologic findings were evaluated through the Chisholm and Mason classification: the presence of at least 1 focus of mononuclear leukocytes in 4 mm2 was considered positive (Daniels et al.). US of both the parotid and submandibular glands was assessed with the grading proposed by Salaffi et al.(range 0-4).
Results 70 of the110 considered patients were classified as affected by SS (SS group: 4 males and 66 females, mean age 52,5, 41 with primary SS and 29 with secondary SS). In 40 patients the data were inadequate for the definition of SS (NSS group: 2 males and 38 females, mean age 48,2, 22 with undifferentiated connective tissue disease (UCTD) and 18 with essential sicca syndrome). Sonographic abnormalities (range 1-4) were found in 91,4% of the SS patients vs 75,0% in NSS group (p<0.02); the grading values 0 and 1 were more frequent in NSS patients (65% vs 24,3%; p<0.000), while the values between 2 and 4 resulted more frequent in the SS group (75,7% vs 35%; p<0.00); therefore the US grading range 2-4 showed a fair balance between sensitivity (75,7%) and specificity (65,0%) in SS patients. 68,5% of the SS patients presented positive histology together with US abnormalities 1-4 vs 0% in NSS group (p<0.00);60,0% of the SS patients showed association between positive histology and US grading value 2-4 vs 0% in NSS group (p<0.00); 82,3% of the SS patients with positive histology presented an US grading value 2-4 and 51,0% grading 3-4 vs 55,5% and 11,1% of the SS patients with negative histology (p<0.00 and p<0.002,respectively). 44.3% of the SS patients showed association between anti-Ro/anti-La antibodies positive detection and US grading value 2-4 vs 0% of the NSS patients; 11,4% of the SS group presented instead association between anti-Ro/anti-La antibodies positive detection and US grading value 0-1 vs 100% of the NSS patients; 79,5% of the SS group with anti-Ro/anti-La antibodies positive detection showed an US grading value 2-4 vs 0% of the NSS patients (p<0.002); 20,5% of the SS patients with anti-Ro/anti-La antibodies positive detection presented an US grading value 0-1 vs 100% of the NSS patients (p<0.002).
Conclusions The mayor salivary gland US in our experience, if considered by itself was shown to be a sensitive but nonspecific technique, very specific but less sensitive when considered in combination with histology or anti-Ro/anti-La antibodies positivity. The SS patients presented more often an advanced US grading than the NSS patients. Finally in the SS patients with positive histology or anti-Ro/anti-La antibodies positivity we frequently found a more advanced US grading.
Disclosure of Interest None Declared