Diagnostic concordance and added value of doppler ultrasound and extended histopathologic features in primary Sjögren disease

초록

ObjectivesTo evaluate the diagnostic concordance between salivary gland ultrasound (SGUS) and minor salivary gland biopsy (MSGB) in suspected primary Sj & ouml;gren disease (SjD), and to assess the added value of Doppler ultrasound and extended histopathologic features beyond the focus score (FS).MethodsWe retrospectively analyzed 128 patients who underwent both SGUS and MSGB during diagnostic evaluation for SjD. SGUS was graded using the OMERACT system; MSGB was assessed for FS and additional features including fibrosis, atrophy, ductal dilatation, and lymphoepithelial lesions (LELs). The final clinical diagnosis was determined by expert rheumatologists. Diagnostic accuracy, concordance (Cohen's kappa), and receiver operating characteristics (ROC) were analyzed.ResultsOf 128 patients, 95 were diagnosed with SjD. The overall SGUS-MSGB concordance rate was 67.2% (kappa = 0.334). Among discordant cases, patients with positive biopsy but negative SGUS (n = 23) had a significantly higher SjD diagnosis rate than those with positive SGUS but negative biopsy (n = 19) (95.7% vs. 68.4%; OR = 10.15, p = 0.034). FS >= 1 had the highest diagnostic accuracy (AUC = 0.853), while adding extended features did not improve performance. Doppler ultrasound failed to enhance diagnostic accuracy, particularly in grayscale SGUS-negative patients. In MSGB-negative patients, SGUS positivity, anti-Ro/SSA antibody, and histologic fibrosis were independently associated with SjD.ConclusionSGUS and MSGB demonstrate only fair diagnostic concordance and reflect complementary aspects of glandular involvement. Doppler ultrasound and extended histologic features provide limited incremental value.Key Points center dot In suspected primary SjD, SGUS and MSGB demonstrate modest agreement (kappa = 0.334), with a 32.8% discordance rate.center dot MSGB with focus score >= 1 demonstrated the highest diagnostic accuracy, while extended histologic features (fibrosis, atrophy, LEL) did not provide additional diagnostic value.center dot Doppler ultrasound failed to improve diagnostic accuracy, especially in patients with structurally normal glands on grayscale SGUS (OMERACT grade 0-1).center dot In MSGB-negative patients, SGUS positivity, anti-Ro/SSA antibody, and histologic fibrosis were independently associated with expert-diagnosed SjD, supporting a complementary diagnostic approach.ConclusionSGUS and MSGB demonstrate only fair diagnostic concordance and reflect complementary aspects of glandular involvement. Doppler ultrasound and extended histologic features provide limited incremental value.Key Points center dot In suspected primary SjD, SGUS and MSGB demonstrate modest agreement (kappa = 0.334), with a 32.8% discordance rate.center dot MSGB with focus score >= 1 demonstrated the highest diagnostic accuracy, while extended histologic features (fibrosis, atrophy, LEL) did not provide additional diagnostic value.center dot Doppler ultrasound failed to improve diagnostic accuracy, especially in patients with structurally normal glands on grayscale SGUS (OMERACT grade 0-1).center dot In MSGB-negative patients, SGUS positivity, anti-Ro/SSA antibody, and histologic fibrosis were independently associated with expert-diagnosed SjD, supporting a complementary diagnostic approach.

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