OP0312 THE IMPACT OF AN ULTRASOUND ATLAS FOR SCORING SALIVARY GLANDS IN PRIMARY SJÖGREN’S SYNDROME: A RELIABILITY EXERCISE
Authors: N. S. Schmidt, V. Fana, H. M. Lindegaard, L. Terslev
Journal: Annals of the Rheumatic Diseases (2020)

Background: Salivary gland ultrasound (SGUS) may have the potential of facilitating diagnosis and therapy monitoring of salivary gland disease in patients with primary Sjögren’s syndrome (pSS). A novel consensus based OMERACT SGUS scoring system for the parotid and submandibular glands has recently been developed.(1) Objectives: To assess the reliability of 3 readers using the written definition of the scoring system provided by the OMERACT group and subsequent the impact of a SGUS-atlas based on the OMERACT SGUS scoring system. Methods: 3 sonographers with 6 months to 10 years US experience performed a US exercise of 30 SGUS images of patients with SS. 16 images were of the submandibular gland (SMG) and 14 images of the parotid gland (PG) ranging from normal to varying degrees of abnormalities. The images were scored using the US scoring system provided by the OMERACT-group and subsequently using a SGUS atlas made for the study consisting of 4 images of every grade 0-3 of both the SMG and the PG. The readings were performed over 4 rounds: the first reading without using the atlas and second reading using the atlas 1 week later. The 30 images were scrambled by a physician not included in the readings and a third and fourth reading were performed without and with the atlas respectively – with 1 week in between. Inter- and intra-reader reliability were calculated by kappa-tests. Results: Light weighted Kappa for intra- and inter-reliability was determined for each reading. The results of the intra-reader reliability was ranging from moderate to almost perfect with improvement in the 2 nd round of readings and with use of the atlas. The inter-reader reliability was moderate and better in the 2 nd round of readings. Readings improved with the atlas. Details are shown in table 1. Table 1 Intrareader reliability Weighted Kappa: Weighted Kappa, reader 1-3 Reading 1 without atlas vs. reading 1 with atlas 0.93, 0.85, 0.80 Reading 2 without atlas vs. reading 2 with atlas 0.78, 0.93, 0.78 Reading 1 without atlas vs. reading 2 without atlas 0.78, 1.00, 0.58 Reading 1 with atlas vs. reading 2 with atlas 0.93, 0.93, 0.86 Interreader reliability Weighted Kappa: Weighted Kappa: mean (min – max ) Reading 1 without atlas 0.50 (0.33 – 0.72) Reading 1 with atlas 0.55 (0.39 – 0.86) Reading 2 without atlas 0.55 (0.33 – 0.93) Reading 2 with atlas 0.60 (0.40 – 0.93) Conclusion: The results of the inter- and intra-reliability showed a moderate to almost perfect agreement respectively, of scoring SGUS in patients with pSS and especially in the 2 nd round of readings indicating that training and the SGUS atlas increased the reliability. References: [1]Jousse-Joulin S, D'Agostino MA, Nicolas C, Naredo E, Ohrndorf S, Backhaus M, et al. Video clip assessment of a salivary gland ultrasound scoring system in Sjogren's syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise. Annals of the rheumatic diseases. 2019;78(7):967-73. Disclosure of Interests: Nanna Surlemont Schmidt: None declared, Viktoria Fana: None declared, Hanne Merete Lindegaard: None declared, Lene Terslev Speakers bureau: LT declares speakers fees from Roche, MSD, BMS, Pfizer, AbbVie, Novartis, and Janssen.