Mo Ying-Qian, Hao Shao-Yun, Li Qian-Hua, Liang Jin-Jian, Luo Yi, Lan Yu-Qing, Zhong Jiang-Long, Wang Jun-Wei, Zhang Xue-Pei, Huang Wen-Ke, Dai Lie
Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China.
Department of Ultrasonography, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China.
Ther Adv Musculoskelet Dis. 2021 Apr 22;13:1759720X211010592. doi: 10.1177/1759720X211010592. eCollection 2021.
Although a positive result of labial salivary gland biopsy (LSGB) is critical for the diagnosis of Sjögren's syndrome, rheumatologists prefer assessing the non-invasive objective items and hope to learn the predicted probability of positive LSGB before referring patients with suspected Sjögren's syndrome to receive biopsy. This study aimed to explore the predictive value of combined B-mode ultrasonography (US) and shear-wave elastography (SWE) examination on LSGB results.
A derivation cohort and later a validation cohort of patients with suspected Sjögren's syndrome were recruited. All participants received clinical assessments, B-mode US and SWE examination on bilateral parotid and submandibular glands before LSGB. Positive LSGB was defined by a focus score ⩾1 per 4 mm of glandular tissue.
In the derivation cohort of 91 participants, either the total US scores or the total SWE values of four glands significantly distinguished patients with positive LSGB from those with negative results (area under the curve (AUC) = 0.956, 0.825, both < 0.001). The positive predictive value (PPV) was 100% in patients with total US scores ⩾9 or with total SWE values ⩾33 kPa. The negative predictive value (NPV) was 100% in patients with total US scores <5, but 68% in patients with total SWE values <27 kPa. A matrix risk model was derived based on the combination of total US scores and total SWE values. Patients can be stratified into high, moderate, and low risk of positive LSGB. In the validation cohort of 52 participants, the PPV was 94% in the high-risk subpopulation and the NPV was 93% in the low-risk subpopulation.
A novel matrix risk model based on the combined B-mode US and SWE examination can help rheumatologists to make a shared decision with suspected Sjögren's syndrome patients on whether the invasive procedure of LSGB should be performed.
尽管唇腺活检（LSGB）的阳性结果对干燥综合征的诊断至关重要，但风湿病学家更倾向于评估非侵入性客观指标，并希望在将疑似干燥综合征的患者转诊进行活检之前了解LSGB阳性的预测概率。本研究旨在探讨B型超声（US）联合剪切波弹性成像（SWE）检查对LSGB结果的预测价值。
招募了一个推导队列以及随后的一个疑似干燥综合征患者的验证队列。所有参与者在LSGB之前均接受了临床评估、双侧腮腺和下颌下腺的B型超声和SWE检查。LSGB阳性定义为每4mm腺组织的焦点评分⩾1。
在91名参与者的推导队列中，四个腺体的总US评分或总SWE值均能显著区分LSGB阳性患者和阴性患者（曲线下面积（AUC）=0.956、0.825，均<0.001）。总US评分⩾9或总SWE值⩾33kPa的患者阳性预测值（PPV）为100%。总US评分<5的患者阴性预测值（NPV）为100%，但总SWE值<27kPa的患者NPV为68%。基于总US评分和总SWE值的组合得出了一个矩阵风险模型。患者可被分为LSGB阳性的高、中、低风险组。在52名参与者的验证队列中，高风险亚组的PPV为94%且低风险亚组的NPV为93%。
基于B型超声联合SWE检查的新型矩阵风险模型可帮助风湿病学家与疑似干燥综合征患者就是否应进行侵入性的LSGB检查共同做出决策。
