Elisa Astorri1, Nurhan Sutcliffe2, Polly S Richards3, Krishna Suchak4, Costantino Pitzalis1, Michele Bombardieri1, Anwar R Tappuni4. 1. Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. 2. Department of Rheumatology, Barts Health NHS Trust and Queen Mary University of London, London, UK. 3. Department of Radiology, Barts Health NHS Trust, London, UK. 4. Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Abstract
BACKGROUND: The international classification criteria for Sjögren's syndrome necessitate the presence of either extractable nuclear antibody or a characteristic focal inflammatory infiltrate in a minor salivary gland. Thus, patients who are extractable nuclear antibody-negative will need to have a labial salivary gland biopsy, which is an invasive procedure associated with morbidity. The aim of this study was to evaluate the viability of ultrasound imaging of the major salivary glands as a predictor of the histology to explore whether ultrasound can help in stratifying Sjögren's patients and reduce the need for biopsy. METHODS: The records of 85 patients suspected of having Sjögren's syndrome and who have had biopsy and ultrasound were analysed retrospectively. The histology and the ultrasound were reported by experts independently. The reporting was impartial as the examiners were blinded to the results of the other investigations and to the diagnosis. RESULTS: Out of the 85 patients, 34 had positive ultrasound, 29 of whom also had positive histology. Fifty-one patients had negative ultrasound, of whom 49 were also negative for histological features of Sjögren's syndrome. The results show that the ultrasound had a positive predictive value of 85% and a striking negative predicative value of 96% of the histology results. The overall concordance between the ultrasound and the histology was 91% (Kappa = 0.826). CONCLUSIONS: Our study shows that potentially the ultrasound has a role in stratifying patients who are extractable nuclear antibody-negative and can help to prioritize the biopsy for those who have sonographic evidence of SS.
BACKGROUND: The international classification criteria for Sjögren's syndrome necessitate the presence of either extractable nuclear antibody or a characteristic focal inflammatory infiltrate in a minor salivary gland. Thus, patients who are extractable nuclear antibody-negative will need to have a labial salivary gland biopsy, which is an invasive procedure associated with morbidity. The aim of this study was to evaluate the viability of ultrasound imaging of the major salivary glands as a predictor of the histology to explore whether ultrasound can help in stratifying Sjögren's patients and reduce the need for biopsy. METHODS: The records of 85 patients suspected of having Sjögren's syndrome and who have had biopsy and ultrasound were analysed retrospectively. The histology and the ultrasound were reported by experts independently. The reporting was impartial as the examiners were blinded to the results of the other investigations and to the diagnosis. RESULTS: Out of the 85 patients, 34 had positive ultrasound, 29 of whom also had positive histology. Fifty-one patients had negative ultrasound, of whom 49 were also negative for histological features of Sjögren's syndrome. The results show that the ultrasound had a positive predictive value of 85% and a striking negative predicative value of 96% of the histology results. The overall concordance between the ultrasound and the histology was 91% (Kappa = 0.826). CONCLUSIONS: Our study shows that potentially the ultrasound has a role in stratifying patients who are extractable nuclear antibody-negative and can help to prioritize the biopsy for those who have sonographic evidence of SS.
Authors: Giuliana Maria Concetta La Paglia; Olga Sanchez-Pernaute; Alessia Alunno; Maria José Martínez-Becerra; Fredeswinda Romero-Bueno; Sheila Recuero; Pablo Eder Borges; Ignacio Mahillo-Fernández; Jesús Garrido; Roberto Gerli; Gabriel Herrero-Beaumont; Esperanza Naredo Journal: Clin Rheumatol Date: 2019-11-01 Impact factor: 2.980
Authors: Roland Jonsson; Karl A Brokstad; Malin V Jonsson; Nicolas Delaleu; Kathrine Skarstein Journal: Eur J Oral Sci Date: 2018-10 Impact factor: 2.612
Authors: Juan Carlos Nieto-González; Juan G Ovalles-Bonilla; Eduardo Estrada; Belén Serrano-Benavente; Julia Martínez-Barrio; Carlos M González-Fernández; Roberto González-Benítez; Cristina Vergara Dangond; Indalecio Monteagudo; Luis Collado Yurrita; Esperanza Naredo; Francisco Javier López-Longo Journal: J Int Med Res Date: 2018-04-12 Impact factor: 1.671