title: Contribution of salivary gland ultrasonography to the diagnosis of Sjögren's syndrome: toward new diagnostic criteria?
abstract: OBJECTIVE
  To determine the accuracy of salivary gland ultrasonography (SGUS) for diagnosing primary Sjögren's syndrome (SS) and to suggest modifications of the American-European Consensus Group (AECG) classification criteria.
  
  
  METHODS
  We conducted a cross-sectional study in a prospective cohort of patients with suspected primary SS that was established between 2006 and 2011. The echostructure of the bilateral parotid and submandibular glands was graded from 0 to 4, and the gland size was measured; blood flow to the parotid gland was assessed using Doppler waveform analysis. The reference standard was a clinical diagnosis of primary SS as determined by a group of experts blinded to the results of SGUS. Receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic value of the 0-4-point echostructure grade for each of the 4 major salivary glands, the sum of the grades for the 4 glands, and the highest grade among the 4 glands.
  
  
  RESULTS
  Of the 158 patients in the study, 78 had a diagnosis of primary SS according to the experts, including 61 patients (78.2%) who met the AECG criteria. Doppler waveform analysis and gland size measurement showed poor diagnostic performance. The results of ROC curve analysis showed that the highest grade among the 4 glands provided the best diagnostic value. The optimal grade cutoff was 2 (62.8% sensitivity and 95.0% specificity). A weighted score was constructed using scores for the 5 variables selected by logistic regression analysis, as follows: (salivary flow×1.5)+(Schirmer's test×1.5)+(salivary gland biopsy×3)+(SSA/SSB×4.5)+(SGUS×2). According to ROC curve analysis, a score of ≥5 of 12.5 had 85.7% sensitivity and 94.9% specificity, compared with 77.9% sensitivity and 98.7% specificity for the AECG criteria. The addition of SGUS to the AECG criteria increased sensitivity to 87.0% but did not change specificity.
  
  
  CONCLUSIONS
  Modifications of the AECG criteria, including the addition of a SGUS score, notably improved diagnostic performance.
authors.affiliation: Brest University Medical School Hospital, Brest, France.
authors.forename: Divi
authors.initials: D
authors.lastname: Cornec
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jousse-Joulin
authors.forename: Jacques-Olivier
authors.initials: JO
authors.lastname: Pers
authors.forename: Thierry
authors.initials: T
authors.lastname: Marhadour
authors.forename: Béatrice
authors.initials: B
authors.lastname: Cochener
authors.forename: Sylvie
authors.initials: S
authors.lastname: Boisramé-Gastrin
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Nowak
authors.forename: Pierre
authors.initials: P
authors.lastname: Youinou
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.forename: Valérie
authors.initials: V
authors.lastname: Devauchelle-Pensec
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012469:Salivary Glands / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D012859:Sjogren's Syndrome / Q000000981:diagnostic imaging*; D014463:Ultrasonography