THU0282  ULTRASOUND FINDINGS IN THE SALIVARY GLANDS IN A COHORT OF PATIENTS WITH SUSPECTED SJÖGREN'S SYNDROME

Abstract

Background: Ultrasound has been shown to be a promising tool in the evaluation of salivary glands for parenchyma changes with the potential to improve diagnosis. The changes range from mild inhomogeneity of the glandular tissue to large vesicular changes almost eliminating all normal glandular tissue. American-European Consensus Group (AECG) classification criteria for SS are often used diagnostically (1). Objective(s): To describe ultrasound findings in salivary glands (SGUS) in a cohort of patients with suspected Sjogren's syndrome (SS) and assess their positive and negative predictive value for the diagnosis. Method(s): 191 consecutive patients with suspected SS (ocular and/or oral dryness) referred to the department of Rheumatology between March 2017 and March 2018 were evaluated by SGUS as part of the initial evaluation. All had unstimulated sialometry, Schirmer's test and laboratory test done (including autoantibodies (ANA screening, Rheumatoid factor and anti-cyclic citrullinated peptide, anti-Ro/SSA and anti-La/SSB), and screenings test for hepatitis B+C). In doubtful cases, a minor salivary gland (MSG) biopsy was performed. SGUS was performed with a GE Logiq E9 equipped with a linear ML6-15 probe and included grey-scale evaluation of the submandibular and parotid gland bilaterally. SGUS was considered abnormal when moderate to severe inhomogeneity with anechoic or hypoechoic areas was present in at least one gland. Result(s): 63 patients were diagnosed with SS according to the AECG classification criteria - 57 patients with primary SS, 6 with secondary SS. 128 patients with sicca symptoms did not fulfill AECG criteria for SS and none were diagnosed with SS based on other parameters. Demographic data for the cohort is shown in table 1.55 patients had MSG biopsy performed. The SGUS examination and evaluation was performed in less than 15 min per patient. The sensitivity of SGUS is 0.51 and the specificity 0.88; the PPV of SGUS for the SS diagnosis was 0.68 and the NPV was 0.78 The sensitivity of SGUS for positive MSG biopsy was 0.29 and the specificity 0.82 - the PPV was 0.50 and the NPV was 0.65; for abnormal sialometry the sensitivity of SGUS was 0.32 and the specificity 0.82 -the PPV for SGUS was 0.64 and NPV was 0.55. Table 2 shows the association between SGUS and final diagnosis, MSG biopsy and sialometry, respectively. (Table Presented) Conclusion(s): SGUS has a high specificity but poor sensitivity for the SS diagnosis with a good NPV and a high specificity for positive MSG biopsy and positive sialometry. SGUS is a feasible method for the evaluation of structural changes in the salivary gland and may aid in the diagnosis and classification of SS.