Diagnostic value of high-frequency ultrasound assessment of the lacrimal glands for primary Sjögren's disease

OBJECTIVES: The aim of the study was to evaluate the ultrasound findings in lacrimal glands in a cohort of patients with suspected primary Sjögren's disease (pSjD) and to assess the relationship with the diagnosis and the association with functional tests and autoantibodies.

METHODS: Patients with suspected pSjD, evaluated by salivary gland ultrasound (SGUS) and lacrimal gland (LGUS) as part of the diagnostic set-up were included. All had unstimulated sialometry, Schirmer's test and laboratory test done (including autoantibodies). Ultrasound examination was performed with a GE Logiq E10 (a linear 4-20 MHz transducer for SGUS and a 6-24 MHz hockey stick transducer for LGUS). The OMERACT consensus-based greyscale scoring system (0-3) for salivary glands was applied for all glands. A score of ≥2 was considered pathological.

RESULTS: 30 patients were included, one was subsequently excluded due to missing data, 13 were diagnosed with pSjD according to the American College of Rheumatology/EULAR classification criteria. The sensitivity and specificity for LGUS for pSJD diagnosis were 61.5 and 87.5, respectively. The PPV and NPV values were 80.0 and 73.3, respectively-better than SGUS for the current cohort. There was no statistically significant association between LGUS and Schirmer's test positivity (p value: 0.86), but there was a significant association between LGUS and SSA (OR: 17.4, p=0.005) as well as SSB (OR: 23.0, p=0.003).

CONCLUSION: LGUS has moderate sensitivity and high specificity for the diagnosis of pSjD. The OMERACT scoring system appears relevant for scoring pathology in the lacrimal glands using grade ≥2 as cut-off and may be a valuable supplementary tool for diagnostic evaluation in pSjD.