title: Ultrasound of the salivary glands is a strong predictor of labial gland biopsy histopathology in patients with sicca symptoms.
abstract: BACKGROUND
  The international classification criteria for Sjögren's syndrome necessitate the presence of either extractable nuclear antibody or a characteristic focal inflammatory infiltrate in a minor salivary gland. Thus, patients who are extractable nuclear antibody-negative will need to have a labial salivary gland biopsy, which is an invasive procedure associated with morbidity. The aim of this study was to evaluate the viability of ultrasound imaging of the major salivary glands as a predictor of the histology to explore whether ultrasound can help in stratifying Sjögren's patients and reduce the need for biopsy.
  
  
  METHODS
  The records of 85 patients suspected of having Sjögren's syndrome and who have had biopsy and ultrasound were analysed retrospectively. The histology and the ultrasound were reported by experts independently. The reporting was impartial as the examiners were blinded to the results of the other investigations and to the diagnosis.
  
  
  RESULTS
  Out of the 85 patients, 34 had positive ultrasound, 29 of whom also had positive histology. Fifty-one patients had negative ultrasound, of whom 49 were also negative for histological features of Sjögren's syndrome. The results show that the ultrasound had a positive predictive value of 85% and a striking negative predicative value of 96% of the histology results. The overall concordance between the ultrasound and the histology was 91% (Kappa = 0.826).
  
  
  CONCLUSIONS
  Our study shows that potentially the ultrasound has a role in stratifying patients who are extractable nuclear antibody-negative and can help to prioritize the biopsy for those who have sonographic evidence of SS.
authors.affiliation: Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Elisa
authors.initials: E
authors.lastname: Astorri
authors.affiliation: Department of Rheumatology, Barts Health NHS Trust and Queen Mary University of London, London, UK.
authors.forename: Nurhan
authors.initials: N
authors.lastname: Sutcliffe
authors.affiliation: Department of Radiology, Barts Health NHS Trust, London, UK.
authors.forename: Polly S
authors.initials: PS
authors.lastname: Richards
authors.affiliation: Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Krishna
authors.initials: K
authors.lastname: Suchak
authors.affiliation: Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Costantino
authors.initials: C
authors.lastname: Pitzalis
authors.affiliation: Centre for Experimental Medicine & Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Michele
authors.initials: M
authors.lastname: Bombardieri
authors.affiliation: Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Anwar R
authors.initials: AR
authors.lastname: Tappuni
mesh_terms: D000328:Adult; D000368:Aged; D000974:Antibodies, Antinuclear / Q000097:blood; D034961:Antigens, Nuclear / Q000097:blood; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012469:Salivary Glands / Q000000981:diagnostic imaging / Q000473:pathology*; D012470:Salivary Glands, Minor / Q000473:pathology; D012859:Sjogren's Syndrome / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D000069453:Ultrasonic Waves
chemical_list: D000974:Antibodies, Antinuclear; D034961:Antigens, Nuclear; C035356:SS-A antibodies; C035357:SS-B antibodies
keywords: dry mouth; minor salivary gland histology; salivary glands ultrasound; sicca; sjogren's syndrome