title: Diagnostic properties of ultrasound of major salivary glands in Sjögren's syndrome: a meta-analysis.
abstract: OBJECTIVE
  To perform a systematic review and meta-analysis on studies examining the properties of ultrasonography of major salivary glands for diagnosing Sjögren's syndrome.
  
  
  METHODS
  We searched for the literature on eight databases. The quality of included articles was assessed with the QUADAS-2 tool. Publication bias, pooled sensitivity, specificity, diagnostic odds ratio, and 95% confidence intervals (95%CI) were calculated. Meta-regression analysis was performed.
  
  
  RESULTS
  We identified 37 studies and 33 ultrasonographic scoring systems. High risk of bias was observed in 'patient selection', 'conduct and interpretation of ultrasound', and 'flow of patients and timing of tests' in 78%, 70%, and 51% of the studies. We included 29 studies in the meta-analysis. Publication bias was highly probable. Pooled sensitivity was 0.69 (95%CI: 0.67-0.71), specificity 0.92 (95%CI: 0.91-0.93), and diagnostic odds ratio 33.89 (95%CI: 20.75-55.35). Significant heterogeneity was detected between studies. Meta-regression analysis showed that studies with high risk of bias in 'conduct and interpretation of ultrasound' and studies evaluating only parenchymal homogeneity had higher log diagnostic odds ratio (1.09 and 2.49, respectively, p < 0.05).
  
  
  CONCLUSIONS
  The quality of current studies is low, thus not allowing to judge the likelihood of salivary gland ultrasonography as a reliable and practical tool in diagnosing Sjögren's syndrome.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Delli
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Department of Rehabilitation, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: P U
authors.initials: PU
authors.lastname: Dijkstra
authors.affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Stel
authors.affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Bootsma
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Vissink
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: F K L
authors.initials: FK
authors.lastname: Spijkervet
mesh_terms: D006801:Humans; D017594:Publication Bias; D012469:Salivary Glands / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D012859:Sjogren's Syndrome / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Sjögren's syndrome; diagnosis; meta-analysis; quality; ultrasonography