AB0822 LACRIMAL GLAND ULTRASOUND DEMONSTRATES GOOD INTEROBSERVER RELIABILITY
Authors: T. Yang, A. Coumou, K. Delli, J. F. Van Nimwegen, A. J. Stel, N. Sluijpers, S. Arends, F. G. M. Kroese, H. Bootsma, S. Pringle
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Sjögren's Disease (SjD) is a chronic systemic autoimmune disease targeting the salivary gland (SG) and lacrimal gland (LG). Ultrasound(US)is a noninvasive and repeatable imaging technique which has been used to evaluate the major salivary glands in SjD. In recent years several US scoring systems for the SG have been applied to assist in the classification of SjD[1]. However, studies on lacrimal gland US of SjD patients are still limited. <h3>Objectives:</h3> To assess the interobserver reliability of US of LG in patients clinically suspected of SjD. <h3>Methods:</h3> Ten consecutive outpatients with clinically suspected SjD underwent US evaluation of both LGs. US images and videos for each LG were assessed and scored by 4 independent observers using the Hocevar and OMERACT scoring systems. If no lacrimal gland was judged as visible in either still images or video files by at least 3 scorers, the gland was not included for further analysis. For patients with an invisible gland, we only considered the score of single side LG when performing the analysis. The Hocevar scoring system [2] includes echogenicity (compared to the surrounding tissue), parenchymal homogeneity, presence of hypoechogenic areas, hyperechogenic reflections, and clearness of posterior glandular border (total score range 0-26). The OMERACT scoring system [3] evaluates semi-quantitively greyscale and color Doppler (both scores range from 0-3 per eye). The interobserver reliability was calculated using intraclass correlation coefficient (ICC). ICC values were interpreted as follows: 0.00-0.20: poor;0.20-0.40: fair;0.40-0.60: moderate; 0.60-0.80: good; and 0.80-1.00: excellent) <h3>Results:</h3> Two LG from 2 patients were excluded from analysis, following consensus on difficulty identifying the gland. Eighteen lacrimal glands from ten patients were finally included. Examples of high-scoring and low-scoring LG US are provided (Figure 1). The ICC of the total Hocevar score of each single gland was fair, with an ICC of 0.52, ICC of each patient (both LGs) was good with an ICC of 0.70. The ICC of the greyscale OMERACT score of each gland was good with a value of 0.62 and the total score of each patient was also good, with an ICC of 0.71. Finally, the color Doppler OMERACT score ICC of each gland is moderate, calculated at 0.58 and the total score of each patient is good, generating an ICC of 0.72. <h3>Conclusion:</h3> Our preliminary study shows that both greyscale and color Doppler US of LG are reliable imaging techniques for patients with clinically suspected SjD, using all three scoring methods. Interobserver reliability for the total score of both LGs was better than that for unilateral LGs. For further study, intraobserver reliability will be calculated, more patients will be included in the analysis and the specificity and sensitivity of LG ultrasonography in term of classification patients with SjD will be investigated, as well as the comparison with ACR EULAR criteria, salivary gland US and clinical characteristics. <h3>REFERENCES:</h3> [1] K. Delli et al., "Ultrasound of the Major Salivary Glands is a Reliable Imaging Technique in Patients with Clinically Suspected Primary Sjögren's Syndrome," Ultraschall in der Medizin - European Journal of Ultrasound, vol. 39, no. 03, pp. 328–333, Jun. 2018, doi: 10.1055/s-0043-104631. [2] A. Hocevar, A. Ambrozic, B. Rozman, T. Kveder, and M. Tomsic, "Ultrasonographic changes of major salivary glands in primary Sjogren's syndrome. Diagnostic value of a novel scoring system.," Rheumatology (Oxford), vol. 44, no. 6, pp. 768–72, Jun. 2005, doi: 10.1093/rheumatology/keh588. [3] S. Jousse-Joulin et al., "Video clip assessment of a salivary gland ultrasound scoring system in Sjögren's syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise.," Ann Rheum Dis, vol. 78, no. 7, pp. 967–973, 2019, doi: 10.1136/annrheumdis-2019-215024. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>