Shi Zhonghao, Ding Yimei, Dong Xiaoyan, Li Guoling, Li Ben, Hou Jiaqi, Xue Luan
Department of Rheumatology and Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
Department of Ultrasound Imaging, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
Arthritis Res Ther. 2025 Sep 2;27(1):175. doi: 10.1186/s13075-025-03642-4.
To evaluate the diagnostic accuracy of salivary gland ultrasound (SGUS) in patients with high suspicion of Sjögren's Disease (SjD) and to determine its potential role in the diagnostic process.
This study is a cross-sectional diagnostic trial based on a prospective cohort, including 171 patients with high suspicion of SjD. SGUS of the parotid glands (PG) and submandibular glands (SMG) was performed according to the OMERACT scoring system. The predictive value of SGUS for diagnostic outcomes and labial salivary gland biopsy (LSGB) results was analyzed. The correlation between SGUS grading and unstimulated salivary flow rates (USFR) was also assessed using statistical tests.
Of the 171 participants, 130 were diagnosed with SjD. The OMERACT total score demonstrated moderate efficacy in diagnosing SjD, with an area under the curve (AUC) of 0.78, a sensitivity of 0.52, and a specificity of 0.93. In comparison, LSGB showed the highest diagnostic efficacy (AUC = 0.90), followed by anti-Ro/SSA antibodies (AUC = 0.79). Combining the OMERACT total score with either anti-SSA antibodies or LSGB significantly improved diagnostic performance, achieving a specificity of 1.00. The diagnostic accuracy of parotid gland (PG) and submandibular gland (SMG) ultrasound grading was comparable. However, SMG grading exhibited higher sensitivity but lower specificity than PG grading. Additionally, SGUS grade 3 strongly predicted positive biopsy results (AUC = 0.77) and showed a significant correlation with USFR, with Spearman correlation coefficients of -0.45 for PG and -0.51 for SMG.
Although the discriminatory efficacy of SGUS in patients highly suspected of SjD is suboptimal, SGUS may offer significant benefits for a specific subgroup of these patients. Grade 3 ultrasound findings are strongly associated with positive biopsy results and USFR, indicating a potential role in diagnosis and disease evaluation. SGUS may be considered for inclusion in future SjD classification criteria.
评估唾液腺超声（SGUS）对高度怀疑干燥综合征（SjD）患者的诊断准确性，并确定其在诊断过程中的潜在作用。
本研究是一项基于前瞻性队列的横断面诊断试验，纳入了171例高度怀疑SjD的患者。根据OMERACT评分系统对腮腺（PG）和下颌下腺（SMG）进行SGUS检查。分析SGUS对诊断结果和唇腺活检（LSGB）结果的预测价值。还使用统计检验评估SGUS分级与非刺激性唾液流速（USFR）之间的相关性。
171名参与者中，130人被诊断为SjD。OMERACT总分在诊断SjD方面显示出中等疗效，曲线下面积（AUC）为0.78，敏感性为0.52，特异性为0.93。相比之下，LSGB显示出最高的诊断效能（AUC = 0.90），其次是抗Ro/SSA抗体（AUC = 0.79）。将OMERACT总分与抗SSA抗体或LSGB相结合可显著提高诊断性能，特异性达到1.00。腮腺（PG）和下颌下腺（SMG）超声分级的诊断准确性相当。然而，SMG分级的敏感性高于PG分级，但特异性低于PG分级。此外，SGUS 3级强烈预测活检结果为阳性（AUC = 0.77），并与USFR显著相关，PG的Spearman相关系数为-0.45，SMG为-0.51。
尽管SGUS对高度怀疑SjD患者的鉴别效能欠佳，但对于这些患者的特定亚组可能具有显著益处。超声3级表现与活检结果阳性和USFR密切相关，表明其在诊断和疾病评估中具有潜在作用。未来的SjD分类标准中可考虑纳入SGUS。
