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Estimating the reliability of salivary gland ultrasound scoring in Sjögren’s disease: the outcome of an international training workshop
M.A. Suludere1, N.R. Sluijpers2, S. Arends3, A.J. Stel4, S. Jousse-Joulin5, A. Hočevar6, H. Bootsma7, A. Vissink8, K. Delli9
Collaborator/s: A. Thatayatikom1, A. Baer2, A. Dumusc3, A.C.F. Motta4, A.S. Franco5, A. Marino6, C. Baldini7, E. Maeland8, F.R. De Oliveira9, G. La Rocca10, G. Fulvio11, H. Munk12, J. Gales13, J. He14, J. Van Santen15, K.-A. Lee16, M. Jonsson17, M.L. Lemos Lopes18, M. Tomiita19, P. Olsson20, S. Pringle21, S. Cha22, S. Liefers23, V. Risso24, V.F.M. Trevisani25, Y. Jin26, Y. Inoue27
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, the Netherlands. m.a.suludere@umcg.nl
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, the Netherlands.
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, the Netherlands.
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, the Netherlands.
- Department of Rheumatology, Brest University Hospital Centre, Université de Bretagne Occidentale, University of Brest, France.
- Department of Rheumatology, University Medical Centre Ljubljana, Slovenia.
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, the Netherlands.
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen; and Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, the Netherlands.
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen; and Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, the Netherlands.
- Department of Pediatrics, AdventHealth for Children, Orlando, FL, USA.
- Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Rheumatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
- Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, Brazil.
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil.
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome "Campus Biomedico", School of Medicine, Rome, Italy
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Rheumatology, Odense University Hospital, Denmark; University of Southern Denmark, Denmark
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
- Department of Oral Biochemistry, and Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam;
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
- Section for Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
- Department of Clinical Medicine, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Department of Allergy and Rheumatology, Chiba Children's Hospital, Chiba, Japan.
- Department of Rheumatology, Skåne University Hospital, Lund University, Malmö, Sweden
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, the Netherlands
- Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
- University of Geneva, Geneva, Canton de Genève, CH
- Department of Rheumatology, Universidade de Santo Amaro, São Paulo, SP, Brazil
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
International Training Workshop
CER18861
2025 Vol.43, N°12
PI 2102, PF 2110
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PMID: 41328605 [PubMed]
Received: 25/04/2025
Accepted : 22/09/2025
In Press: 17/11/2025
Published: 18/12/2025
Abstract
OBJECTIVES:
Current evidence on how training influences the reliability of salivary gland ultrasound (SGUS) image scoring is scarce, particularly in the context of Sjögren’s disease (SjD). This study aimed to address this gap by evaluating the effect of a structured training workshop on inter-observer reliability in SGUS scoring among clinicians assessing patients with SjD.
METHODS:
25 healthcare professionals from 10 countries, with varying SGUS expertise participated. In random order, SGUS images of 20 suspected SjD patients were assessed before and after the workshop. Images included grey-scale (GS) and colour Doppler (CD) scans of the submandibular and parotid glands and were scored using the OMERACT GS and CD scoring systems. Intraclass correlation coefficients (ICC) assessed overall inter-observer reliability, and participant vs. SGUS-expert reliability (gold standard-participant agreement). Analyses were stratified by SGUS experience (none vs. ≥1 year).
RESULTS:
The inter-observer reliability ICC for the total OMERACT score was 0.68 pre-workshop vs. 0.79 post-workshop for GS, and 0.73 pre-workshop vs. 0.72 post-workshop for CD. Training significantly improved the gold standard-participant ICC GS (0.06±0.12, p=0.020), particularly for the submandibular glands, while the CD ICC showed a minor, non-significant improvement (0.03±0.09, p=0.129). Inexperienced participants (n=11) showed significant ICC improvement for the total GS OMERACT score (0.13±0.13, p=0.012), whereas experienced participants (n=14) showed a negligible change (0.01±0.09, p=0.624). No significant differences were observed for CD scoring.
CONCLUSIONS:
A training workshop was associated with improvements for inter-observer reliability for GS SGUS, particularly in submandibular gland assessment and among inexperienced participants. The effects on CD scoring were minimal.
