Background/Purpose:

In recent years, salivary gland ultrasonography (SGUS) has emerged as a promising tool for the diagnosis and prognostic stratification of patiens with primary Sjögren’s syndrome. However, more studies are needed to demostrate its diagnostic usefulness before it can be used in daily clinical practice. Our objective is to evaluate the diagnostic and prognostic value of salivary gland ultrasonography (SGUS) in primary Sjögren’s syndrome (pSS).

Methods:

Patients with primary SS (fulfilling the American-European Consensus Group criteria of 2002) and controls with secondary SS or sicca syndrome are evaluated using a simplified SGUS scoring system.

Parotid and submandibular glands on both sides were assessed for parenchymal inhomogeneity, which was perfomed by the same ecographist. Echostructural alterations of the salivary glands were graded form 0 to 3, with grades 0 (normal) and 1 (mild inhomogeneity) being interpreted as normal, and grades 2 and 3 as primary SS typical lesions. Associations between SGUS and clinical and laboratory disease were analyzed. Moreover, to test the accuracy for diagnosis of SGUS, we calculated sensitivity, specificity, PPV, NPV and positive/negative likehood ratio.

Results:

Thus far, twenty-five patients have been included, thirteen with pSS and twelve with secondary SS/sicca syndrome. The hypoechoic lesions (score 2 or 3) were found in 76.9% of primary SS patients and in none of controls (p <0.001). Specificity and positive predictive value of abnormal SGUS was 100%, sensitivity and negative predictive values were 76.9% and 80%, respectively. The negative likehood ratio was 0.23 and the positive likehood ratio was > 10, which means that typical SS lesions would improve the probability of having primary SS. However, if the SGUS results negative, another diagnostic test are needed in order to avoide patient misclassification.

Patients with parenchimal heterogeneity, more frequently, had positivity for anti-Ro/SSA (p=0.022), anti-La/SSB (p=0.005) and rheumatoid factor (p=0.007). Moreover, the presence of hypergammaglobulinemia, (p=0.001), leucolymphopenia (p<0.001), and elevated ESR (p<0.001) was associated with typical pathologic SGUS. Consequently, the EULAR Sjögren’s syndrome disease activity index (ESSDAI) was higher in patients with abnormal SGUS (p=0.025). We could not detect an association with age, disease duration, ANA positivity, complement level, anemia and, suprinsingly, extraglandular involvement.

Conclusion:

In our preliminary study, assessment of parenchyma dyshomogeneity with SGUS is highly specific in differentiating primary SS from idiopathic sicca syndrome or Secondary SS. Moreover, this technic can provide prognostic stratification in patients with primary SS.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/diagnostic-and-prognostic-value-of-salivary-gland-ultrasonography-in-primary-sjogrens-syndrome-a-preliminary-study/