What is the best salivary gland ultrasonography scoring methods for the diagnosis of primary or secondary Sjögren's syndromes?

Abstract : Objective: To evaluate the performance of salivary gland ultrasonography for the diagnosis of primary and secondary Sjögren's syndromes (pSS and sSS).Method: Multicenter cross-sectional study on 97 patients with clinical sicca symptoms. The pSS (n = 39) and the sSS (n = 22) met the American-European Consensus Group (AECG) classification criteria. The control patients (n = 36) with sicca symptoms did not fulfill the AECG criteria. Four scores were used to evaluate the 4 major salivary gland echostructure: the Salaffi score (0-16), Jousse-Joulin score (0-4), Hocevar score (0-48) and Milic score (0-12).Results: The medians of ultrasonographic (US) scores were higher in the pSS and sSS groups than in the control group (p <0.001). The receiver-operating characteristic (ROC) curves and the positive likelihood ratio (LR+) of the four scores showed a good diagnostic performance for the US diagnosis of pSS and sSS. Respectively, for pSS and sSS, the AUC were 0.891 (95%CI 0.812-0.970) and 0.824 (95%CI 0.695-0.954) for Hocevar score, 0.885 (95%CI 0.804-0.965) and 0.808 (95%CI 0.673-0.943) for Milic score, 0.915 (95%CI 0.848-0.982) and 0.844 (95%CI 0.724-0.965) for Salaffi score, 0.897 (95%CI 0.821-0.973) and 0.851 (95%CI 0.735-0.968) for Jousse-Joulin score. This study showed an interesting inter-observer reproducibility (kappa=0.714 ± 0.131) of the US evaluation with 85,7 % agreement between reader to determine the pathological character of the salivary glands.Conclusion: Salivary gland US is a simple, non-invasive and performant imaging procedure for the diagnosis of pSS and sSS, with Salaffi, Milic and Jousse-Joulin scores.
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Amélie Martel, Guillaume Coiffier, Aurore Bleuzen, Jean Goasguen, Michel de Bandt, et al.. What is the best salivary gland ultrasonography scoring methods for the diagnosis of primary or secondary Sjögren's syndromes?. Joint Bone Spine, Elsevier Masson, In press, 86 (2), pp.211-217. ⟨10.1016/j.jbspin.2018.06.014⟩. ⟨hal-01894638⟩

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