A HIGH-RESOLUTION ultrasound scan of the labial salivary glands could offer a non-invasive alternative to biopsy for diagnosing Sjögren’s disease, a 270-patient study suggests, matching the accuracy of the most heavily weighted diagnostic criteria and helping sort patients into distinct subtypes.
Seeking an Alternative to Biopsy in Sjögren’s
Ultrasound of the major salivary glands is already established in Sjögren’s disease (SjD), but the smaller labial salivary glands, usually sampled by biopsy, have been harder to assess. Researchers tested whether ultra-high frequency ultrasound (UHFUS) of the labial salivary glands could diagnose SjD accurately enough to stand in for that biopsy.
Study Design and Ultrasound Scoring
The study enrolled 270 patients with suspected Sjögren’s disease, comprising 136 with confirmed SjD and 134 with Sicca symptoms, all undergoing UHFUS. Alongside a modified OMERACT grey scale (GS) score, the researchers assessed colour Doppler (CD), a combined GS plus CD score, and distinct morphological lesions. Diagnostic accuracy was calculated against confirmed status, with additional correlation, logistic regression, and cluster analyses to explore phenotypes and the influence of age.
Strong Accuracy and Distinct Phenotypes
The best classification cut-off was a grey scale score of 2 or more, giving 66.2% sensitivity and 84.3% specificity; a score of 3 was highly specific at 98.5%, and very hypoechoic areas appeared only in SjD. Colour Doppler of 2 or more matched grey scale for accuracy, and combining the two improved it further. Substituting the grey scale score for biopsy within the ACR/EULAR criteria achieved excellent accuracy (area under the curve 0.945), and combining ultrasound with SSA antibody status classified over 75% of patients with 94% accuracy. Cluster analysis pointed to different phenotypes, while grey scale accuracy varied with age as Doppler stayed stable.
Towards Ultrasound-Guided Classification
The authors concluded that ultra-high frequency ultrasound of the labial salivary glands is a promising diagnostic tool in Sjögren’s disease when biopsy is not feasible, offering novel insight into lesion types, Doppler signals, patient phenotypes, and age-related change. They suggested these grey scale and Doppler markers could enter clinical practice as a biopsy alternative, while advising that age and phenotype be factored into interpretation. As a single-cohort diagnostic study, the findings would benefit from external validation.
Reference
Fulvio G et al. Ultra-high frequency ultrasound of labial salivary glands in Sjögren’s disease: diagnostic accuracy and patient stratification. RMD Open. 2026;12:e006906.
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