Milic Vera D, Petrovic Radmila R, Boricic Ivan V, Marinkovic-Eric Jelena, Radunovic Goran L, Jeremic Predrag D, Pejnovic Nada N, Damjanov Nemanja S
Institute of Rheumatology, Pathology, Social Medicine and Informatics, and Otorhinolaryngology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
J Rheumatol. 2009 Jul;36(7):1495-500. doi: 10.3899/jrheum.081267. Epub 2009 Jun 1.
To compare an ultrasonographic (US) scoring system of salivary glands with scintigraphy and salivary gland biopsy, in order to evaluate its diagnostic value in primary Sjögren's syndrome (SS).
In 135 patients with suspected SS, the grades of 5 US measures of both parotid and submandibular salivary glands were scored (0-48 scale). Diagnosis of primary SS was established following the American-European Consensus Group criteria of 2002. The patients' total scintigraphic score (0-12 scale) was determined and the histopathological changes of minor salivary glands graded. Area under the receiver-operating characteristic (ROC) curve was employed to evaluate the diagnostic value of the US scoring system.
Primary SS was diagnosed in 107 (79.2%) patients and the remaining 28 subjects (20.8%) constituted the control group. US changes of salivary glands were established in 98/107 patients with SS and in 14/28 controls. Mean US score was 26 in SS patients and 6 in controls. Through ROC curves, US arose as the best performer (0.95 +/- 0.01), followed by scintigraphy (0.86 +/- 0.31). Setting the cutoff score for US at 19 resulted in the best ratio of specificity (90.8%) to sensitivity (87.1%), while setting the cutoff scintigraphic score at 6 resulted in specificity of 86.1% and sensitivity of 67.1%. Among 70 patients with US score >or= 19, a scintigraphic score > 6 was recorded in 54/70 (77.1%) and positive biopsy findings in 62/70 (88.5%) patients.
We show high diagnostic accuracy of a novel US scoring system of salivary glands (0-48) in patients with primary SS comparable to invasive methods, i.e., scintigraphy and salivary gland biopsy.
比较唾液腺超声（US）评分系统与闪烁扫描法及唾液腺活检，以评估其在原发性干燥综合征（SS）中的诊断价值。
对135例疑似SS患者，对腮腺和颌下唾液腺的5项US指标进行评分（0 - 48分）。按照2002年欧美共识小组标准确立原发性SS的诊断。确定患者的闪烁扫描总评分（0 - 12分），并对小唾液腺的组织病理学变化进行分级。采用受试者操作特征（ROC）曲线下面积评估US评分系统的诊断价值。
107例（79.2%）患者被诊断为原发性SS，其余28例（20.8%）构成对照组。107例SS患者中有98例及28例对照组中有14例出现唾液腺US改变。SS患者的平均US评分为26分，对照组为6分。通过ROC曲线分析，US表现最佳（0.95±0.01），其次是闪烁扫描法（0.86±0.31）。将US的截断分数设定为19时，特异性（90.8%）与敏感性（87.1%）的比例最佳，而将闪烁扫描截断分数设定为6时，特异性为86.1%，敏感性为67.1%。在70例US评分≥19的患者中，54/70（77.1%）的闪烁扫描评分>6，62/70（88.5%）的患者活检结果为阳性。
我们发现一种新型唾液腺US评分系统（0 - 48）在原发性SS患者中具有较高的诊断准确性，与侵入性方法即闪烁扫描法和唾液腺活检相当。
