University Hospital Center of Rennes, Rennes, France.
University Hospital Center of Rennes and University of Rennes, CHU Rennes, INSERM, EHESP, IRSET, UMR_S 1085, F-35000 Rennes, France.
Arthritis Care Res (Hoboken). 2022 Nov;74(11):1924-1932. doi: 10.1002/acr.24631. Epub 2022 Aug 5.
To evaluate the diagnostic performance of ultrasound examination of the salivary glands (US-SG) according to the 2019 Outcome Measures in Rheumatology (OMERACT) US scoring system for Sjögren's syndrome (SS).
The present work was a retrospective study based on a multicentric cohort with SS/sicca syndrome. The American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) 2016 classification criteria for SS (a score of ≥4 without ocular staining score), the American-European Consensus Group (AECG) 2002 classification criteria, and clinician experts were considered as reference standards for diagnosis of SS. An OMERACT score of ≥2 according to 2 independent readers defined the diagnosis of SS based on US-SG assessment. Diagnostic performances and interobserver reproducibility of US-SG were assessed.
Forty-two patients fulfilling the ACR/EULAR 2016 criteria for SS were compared to 30 control subjects with sicca syndrome. Twenty-five patients were diagnosed as having SS according to US-SG evaluation, and they were more frequently observed in the SS group (52.5%) than in the control group (10.0%) (P < 0.001). US-SG showed an area under the curve (AUC) of 0.751 (95% confidence interval [95% CI] 0.621, 0.882) for the diagnosis of SS (ACR/EULAR 2016 classification). The inclusion of US-SG in the ACR/EULAR 2016 classification improved sensitivity (91.5% versus 89.4%) with limited decrease of specificity (96.0% versus 100%) and with an AUC of 0.975 (95% CI 0.945, 1.00). Similar results were observed when US-SG was included in the AECG 2002 classification criteria. Interobserver reproducibility of a score of ≥2 according to the 2019 OMERACT US scoring system for SS diagnosis was good (κ = 0.73 [95% CI 0.64, 0.81]). Histologic lymphocyte infiltration of the minor salivary glands was associated with the OMERACT grading of US-SG.
The present study confirms the good specificity of the 2019 OMERACT US classification measures of US-SG for the diagnosis of SS and its feasibility in daily practice.
根据 2019 年风湿病疗效评估（OMERACT）超声评分系统评估唾液腺超声（US-SG）在干燥综合征（SS）中的诊断性能。
本研究是一项基于 SS/sicca 综合征多中心队列的回顾性研究。美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）2016 年 SS 分类标准（无眼部染色评分的评分≥4）、美国欧洲共识组（AECG）2002 年分类标准和临床专家被认为是 SS 诊断的参考标准。根据 2 位独立读者的 OMERACT 评分≥2 定义了基于 US-SG 评估的 SS 诊断。评估了 US-SG 的诊断性能和观察者间可重复性。
将符合 ACR/EULAR 2016 年 SS 标准的 42 例患者与 30 例干燥综合征对照组进行比较。根据 US-SG 评估，25 例患者被诊断为 SS，且在 SS 组中更常见（52.5%）而非对照组（10.0%）（P<0.001）。US-SG 对 SS（ACR/EULAR 2016 分类）的诊断曲线下面积（AUC）为 0.751（95%置信区间[95%CI] 0.621，0.882）。将 US-SG 纳入 ACR/EULAR 2016 分类可提高敏感性（91.5%比 89.4%），特异性略有下降（96.0%比 100%），AUC 为 0.975（95%CI 0.945，1.00）。当将 US-SG 纳入 AECG 2002 分类标准时，也观察到类似的结果。根据 2019 年 OMERACT SS 诊断 US 评分系统≥2 分的观察者间可重复性良好（κ=0.73[95%CI 0.64，0.81]）。小唾液腺的组织学淋巴细胞浸润与 OMERACT US-SG 分级相关。
本研究证实了 2019 年 OMERACT US 分类标准对 SS 的特异性较好，且在日常实践中具有可行性。
