Objective To develop ultrasound (US) definitions and a US novel scoring system for major salivary gland (SG) lesions in patients with primary Sjögren’s syndrome (pSS) and to test their intrareader and inter-reader reliability using US video clips.
Methods Twenty-five rheumatologists were subjected to a three-round, web-based Delphi process in order to agree on (1) definitions and scanning procedure of salivary gland ultrasonography (SGUS): parotid, submandibular and sublingual glands (PG, SMG and SLG); (2) definitions for the elementary SGUS lesions in patients with Sjögren’s syndrome; (3) scoring system for grading changes. The experts rated the statements on a 1–5 Likert scale. In the second step, SGUS video clips of patients with pSS and non-pSS sicca cases were collected containing various spectrums of disease severity followed by an intrareader and inter-reader reliability exercise. Each video clip was evaluated according to the agreed definitions.
Results Consensual definitions were developed after three Delphi rounds. Among the three selected SGs, US assessment of PGs and SMGs was agreed on. Agreement was reached to score only greyscale lesions and to focus on anechoic/hypoechoic foci in a semiquantitative matter or, if not possible on a qualitatively (present/absent) evaluation of fatty or fibrous lesions. Intrareader reliability for detecting and scoring these lesions was excellent (Cohen’s kappa 0.81) and inter-reader reliability was good (Light’s kappa 0.66).
Conclusion New definitions for developing a novel semiquantitative US score in patients with pSS were developed and tested on video clips. Inter-reader and intrareader reliabilities were good and excellent, respectively.
- salivary glands
- primary sjögren syndrome
- reliability exercise
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Handling editor Josef S Smolen
Presented at The results of this paper were presented at the EULAR Congress in oral presentation (Amsterdam 2018).
Correction notice This article has been corrected since it published Online First. The affiliation for the last author has been corrected.
Contributors Conception and design: SJJ, MADA, GAWB, EN, SO, MB, GT, ICV, LT, AI, PC, CHD, FG, WAS, GF, CD, MHS, MAM, AH, SC, GEM, JJA, RT, DKMC, SF, PH, AZ, CG, DSH. Statistical analysis: CN, FG, MADA. Wrote the manuscript: SJJ, MADA, GAWB, ZA. Interpretation of results: SJJ, MADA, GAWB, ZA.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data will be available upon reasonable request from the corresponding author.