Title	Imaging Comparison Of Sjogrens Syndrome
Clinical Question	In a patient with Sjogrens Syndrome (SS) does ultrasound imaging (US) give you comparable diagnostic information as received with sialography.
Clinical Bottom Line	Ultrasound imaging gives comparable results as diagnostic information received from sialography, especially when evaluating submandibular glands.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 20498211 Takagi/2010 360 patients (188 with SS and 172 non-SS) Clinical Comparative Study Key results "The kappa value for intermodality agreement between sialography and parotid ultrasonography was 0.81 and between sialography and submandibular ultrasound was 0.76, indicating very good and good agreement, respectively. The diagnostic ability of parotid ultrasound was significantly lower than that of sialography (p<0.001, McNemar test). However, the diagnostic ability of submandibular ultrasound was comparable to that of sialography (p=0.153)." Takagi 2010 20123387 Obinata/2010 73 Patients Clinincal Comparative Study Key results "There was a statistically significant difference in the sensitivities of sialography and histopathology, in the specificities of sialography and ultrasonography, and in the accuracies of sialography and both ultrasonography and histopathology. The correlation coefficient (r) between sialography and ultrasonography was significantly higher than the others and indicated a good correlation." Obinata 2010
Evidence Search	Sjogrens Syndrome AND ultrasound AND sialography
Comments on The Evidence	In both studies clinical comparisons were made on patients that were pre-selected as having Sjogrens Syndrome (SS) or suspected having SS. In both studies observers were unaware of the results of the prior test taken, which allowed for a less biased results for comparing sialography and sonography.
Applicability	Sjogrens Syndrome cannot be characterized by a single “gold standard” test therefore it takes a combination of criteria for a diagnosis. Due to this, some patients are not easily diagnosed. When salivary gland assessment is deemed necessary by the clinician, ultrasonography compares favorably to sialography in terms of diagnostic accuracy. Ultrasound has the advantage of being low cost, less invasive, and provides no radiation exposure.
Specialty	(Oral Medicine/Pathology/Radiology) (General Dentistry)
Keywords	Ultrasound, Sjogrens Syndrome, sialography
ID#	840
Date of submission	04/01/2011
E-mail	cowlingj@livemail.uthscsa.edu
Author	Jefferson Cowling
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Michaell Huber, DDS
Faculty mentor e-mail	HuberM@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Priscilla Leary and Thomas Adams (San Antonio) on 11/29/2017 A PubMed search was performed in November 2017 for ultrasound, sialography and Sjogren's Syndrome. This search yielded multiple results including a meta-analysis by Song et al 2014(2015) (PMID 25005026) which concludes that ultrasound and sialography provide comparable results. However, the Schafer et al article from 2017 (PMID 28447158) indicates that ultrasound in diagnosing Sjogren's Syndrome is easier, faster, non-invasive and inexpensive. Two additional articles support Schafer’s conclusions: Saied et al. 2013 (PMID 26675053), Parada-Turska 2016 (PMID 27941210) Clinicians are encouraged to consider all aspects of this evidence and discuss options with patients in need of diagnostics regarding Sjogren’s. Overall, this evidence supports the clinical bottom line that both tools are comparable in aiding the diagnosis of Sjogren’s, however when considering patient comfort, clinical time and expense, ultrasound appears ,based on current literature, to be a better choice.