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Ultrasonography of major salivary glands compared with parotid and labial gland biopsy and classification criteria in patients with clinically suspected primary Sjögren’s syndrome
  1. Esther Mossel1,
  2. Konstantina Delli2,
  3. Jolien F van Nimwegen1,
  4. Alja J Stel1,
  5. Frans G M Kroese1,
  6. Fred K L Spijkervet2,
  7. Arjan Vissink2,
  8. Suzanne Arends1,
  9. Hendrika Bootsma1
  10. on behalf of the EULAR US-pSS Study Group
  1. 1Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to Professor Hendrika Bootsma, Department of Rheumatology and Clinical Immunology, University Medical Center Groningen Hanzeplein 1, 9713 GZ, Groningen The Netherland; h.bootsma{at}umcg.nl

Abstract

Objective To assess the validity of ultrasound of major salivary glands (sUS) compared with parotid and labial gland biopsies, sialometry, anti-SSA/Ro antibody status and classification criteria in patients clinically suspected with primary Sjögren’s syndrome (pSS).

Methods 103 consecutive outpatients with clinically suspected pSS underwent sUS. Parenchymal echogenicity, homogeneity, hypoechogenic areas, hyperechogenic reflections and clearness of salivary gland border were scored according to the Hocevar scoring system. Total ultrasound score was calculated as the sum of these domains (range 0–48).

Results Absolute agreement between sUS and parotid (83%) and labial (79%) gland biopsy outcome was good. Negative sUS predicts negative parotid gland biopsy, and positive sUS predicts positive labial gland biopsy. Compared with the American European Consensus Group (AECG) classification, sUS showed an absolute agreement of 82%, sensitivity of 71% and specificity of 92%. Compared with the American College of Rheumatology (ACR) classification, absolute agreement was 86%, sensitivity was 77% and specificity was 92%. Compared with the ACR-European League Against Rheumatism (EULAR) classification, absolute agreement was 80%, sensitivity was 67% and specificity was 94%. Positive sUS predicts classification, but negative sUS does not exclude classification. The combination of positive sUS with presence of anti-SSA/Ro antibodies or negative sUS with absence of anti-SSA/Ro antibodies showed a high predictive value for classification as pSS or non-pSS.

Conclusion In our prospective inception cohort study derived from daily clinical practice, absolute agreement between sUS and salivary gland biopsies was slightly higher for parotid compared with labial gland biopsies. The combination of positive sUS and presence of anti-SSA/Ro antibodies highly predicts classification according to the AECG, ACR and ACR-EULAR classification criteria.

  • sjögren’s syndrome
  • ultrasound
  • salivary gland biopsy
  • classification criteria

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Footnotes

  • Handling editor Tore K Kvien

  • Contributors EM and KD: designed the study, collected, analysed and interpreted data, drafted the article, and approved the version to be published. SA: designed the study, analysed and interpreted data, critically revised the article, and approved the version to be published. JFvN and AJS: critically revised the article and approved the version to be published. FGMK, FKLS, AV and HB: designed the study, critically revised the article and approved the version to be published.

  • Funding No funding has been received for the conduct and/or preparation of this article.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Ethics committee of the University Medical Center Groningen (METC waiver 016/120).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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