Abstract
Noninvasive objective salivary gland ultrasonography (SGU) had been widely used to evaluate major salivary gland involvement in primary Sjögren’s syndrome (pSS) and treatment responses. However, the evaluation score, diagnostic sensitivity, and diagnostic specificity significantly varied among clinical studies. We conducted this meta-analysis to assess the diagnostic accuracy of different SGU scoring systems using the American-European Consensus Group criteria. Of the 1301 articles retrieved from six databases, 24 met the criteria for quality assessment and 14 for meta-analyses. The pooled sensitivities were 75% (0–4) with I2 = 92.0%, 84% (0–16) with I2 = 63.6%, and 75% (0–48) with I2 = 90.9%; the pooled specificities were 93% (0–4) with I2 = 71.5%, 88% (0–16) with I2 = 65.4%, and 95% (0–48) with I2 = 83.9%; the pooled diagnostic odds ratios were 71.26 (0–4) with I2 = 0%, 46.3 (0–16) with I2 = 73.8%, and 66.07 (0–48) I2 = 0%; the areas under the SROC curves were 0.95 (0–4), 0.93 (0–16), and 0.94 (0–48). These results indicated that the 0–4 scoring system has a higher specificity and a less heterogeneity than other systems, and could be used as a universal SGU diagnostic standard.
Highlights
The pathophysiology of s syndrome (SS) has not been fully understood
A meta-analysis of these exiting studies by subgroups using a single gold standard is urgently needed to recommend a guideline regarding whether salivary gland ultrasonography (SGU) is a highly specific primary SS (pSS) diagnostic tool and which SGU scoring system can be used as an universal diagnostic standard
More studies had low concerns in the applicability of patient selection (58.3%) than in the applicability of index test (41.7%) and the applicability of reference standard (0%). These results indicate that the applicability of SGU was high
Summary
A total of 1301 studies were identified in the six databases. One thousand one hundreds and eighty-five studies were excluded per titles and abstracts; 92 per the exclusion criteria. The quality assessment was performed using QUSDAS-2 in the remaining 24 studies (Fig. 1), all of which used the AECG criteria for diagnosis of SS. Four scoring systems were used in 22 studies. Because 0–12 scoring system was used in only two studies, the final meta-analysis focused on the included 14 studies with three scoring systems as subgroups (0–4, 0–16, and 0–48). A total of 3360 patients were enrolled in the 24 studies, including 1976 SS patients and 1384 control subjects (Table 1). Fourteen studies used 0–4 scoring system including 0–3 scoring system (Table 1)[34]. Age range 47–66 18–67 44–64 not specified 20–58 26–65 30–78 20–85 21–78 21–78 28–78 56 ± 13 27–63 21–78 56.8 ± 12.7 20–91 not specified 47 ± 13
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