Juveria Siddiqui MBBS, MRCS, Presenter: Nothing to Disclose

Elisa Astorri, Abstract Co-Author: Nothing to Disclose

Anwar Tappuni, Abstract Co-Author: Nothing to Disclose

Nurhan Sutcliffe MBBS, Abstract Co-Author: Nothing to Disclose

Michele Bombardieri, Abstract Co-Author: Nothing to Disclose

Polly Richards MD, Abstract Co-Author: Nothing to Disclose

Sjogren’s syndrome (SS) is a chronic autoimmune condition affecting both the salivary and lacrimal glands, with resultant xerostomia and keratoconjunctivitis sicca. American-European Consensus Group (AECG) criteria mandates a positive labial salivary gland biopsy (LSGB) for diagnosis, if anti-Ro/La antibody (ENA) tests are negative, in order to distinguish SS from alternative causes of sicca. Due to the high specificity and poor sensitivity of invasive LSGB, it is often reserved for symptomatic ENA positive patients. This study investigates the value of high resolution salivary gland ultrasound (US) in predicting positive LSGB in patients with sicca symptoms.

The US and LSGB reports of 85 consecutive patients attending the SS clinic were compared. All patients had clinical sicca. Major salivary gland US was performed by experienced sonographers and assessed using the modified Salaffi score (>1 is abnormal). Experienced histopathologists utilised the Chisholm and Mason focus score confirmed by immunohistology for CD3/CD20/CD138/CD21 in LSGB evaluation. Both reports were assessed blindly, independent of clinical data.

Out of the 85 patients, 20 were ENA positive (23.5%). 31 patients had a positive LSGB, 15 of whom were ENA positive and 16 of whom were ENA negative. Thus 36 patients met diagnostic criteria for SS, with the remaining 49 classified as sicca only. Abnormal US findings were seen in 34 patients (40%); notably 29 of these patients diagnosed as LSGB positive, giving a significant concordance between the two techniques of 91.76% (Kappa 0.826). Irrespective of diagnosis and ENA status, a negative US gave a negative LSGB predictive value of 96.08% while the positive predictive value of a positive LSGB with abnormal US findings was 85.29%.

This data suggests that a negative US is highly predictive of negative LSGB, in patients with clinical sicca. This is important in ENA negative patients, where LSGB results are most relevant. We propose the incorporation of ultrasound into the SS diagnostic algorithm for risk stratification, with a view to avoiding invasive biopsy in low risk patients.

Negative ultrasound is highly predictive of negative labial salivary gland biopsy in our patient group. Incorporation of this investigation into a diagnostic algorithm for patients with sicca could prevent invasive biopsy in low risk patients.

Siddiqui, J, Astorri, E, Tappuni, A, Sutcliffe, N, Bombardieri, M, Richards, P, Negative High-resolution Salivary Gland Ultrasound: Highly Predictive of Negative Labial Gland Biopsy in Patients with Sicca Symptoms.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004259.html