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Comparative Study
. 2019 Oct;86(5):627-632.
doi: 10.1016/j.jbspin.2019.01.025. Epub 2019 Feb 11.

Assessment of major salivary gland size in primary Sjögren's syndrome: Comparison between clinical examination and ultrasonography

Pauline Marteau  1 , Divi Cornec  2 , Maelenn Gouillou  3 , Sandrine Jousse-Joulin  2 , Dewi Guellec  4 , Sebastian Costa  5 , Thierry Marhadour  4 , Guillermo Carvajal Alegria  2 , Sophie Varache  4 , Yves Gauvin  6 , Sylvie Boisramé  7 , Laetitia Le Pottier  8 , Yves Renaudineau  8 , Jacques-Olivier Pers  9 , Alain Saraux  2 , Valérie Devauchelle-Pensec  2
Affiliations
Comparative Study

Assessment of major salivary gland size in primary Sjögren's syndrome: Comparison between clinical examination and ultrasonography

Pauline Marteau et al. Joint Bone Spine. 2019 Oct.

Abstract

Objective: Parotidomegaly is a criterion of the EULAR Primary Sjögren Syndrome Disease Activity Index (ESSDAI). The cut-off value was set at 3 cm in length for the parotid gland, 2 cm for the submandibular glands. However, clinical appreciation of salivary glands size remains hazardous. The objective is to evaluate inter-observer reproducibility of parotid gland measurement by palpation, and to secondary evaluate its reliability compared to US assessment.

Methods: Outpatients with primary Sjögren Syndrome (pSS) or with a diagnostic suspicion, in a single reference centre, were included. They underwent clinical examination by two independent investigators (VDP and DC), evaluating: parotid gland swelling, parotid gland size (direct measurement with a decameter under the mandibular angle), and pain. Cohen's kappa coefficient was calculated to determine inter-observer concordance for parotid gland swelling, and intraclass correlation coefficient to determine inter-observer agreement of gland size measurement.

Results: Thirty-four patients (33 women, 1 man) were included. Clinical data were complete for 33 patients. Inter-observer concordance Kappa coefficient was 0.90 [0.76-1.00] for detection of parotidomegaly over 66 parotid glands. It was of 0.60 [0.42-0.73] for gland length measurement. For one observer, the median cut-off for defining parotidomegaly was 4.15 cm; for the second observer, it was of 4.92 cm. For submandibular glands palpation, no correlation was found between investigators. A significant association between clinical parotidomegaly and a larger echographic surface was found.

Conclusion: Clinical measurement of parotidomegaly was concordant between two observers on a binary mode (presence/absence). However, concordance on direct measurement was weak. US could be a complementary examination.

Keywords: ESSDAI; Parotidomegaly; Salivary glands; Sjögren's syndrome; ultrasound.

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