{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T07:07:47Z","timestamp":1785222467691,"version":"3.55.0"},"reference-count":33,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Recovery and Resilience Plan","award":["Project funded under the National Recovery and Res"],"award-info":[{"award-number":["Project funded under the National Recovery and Res"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,5,31]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To evaluate the classification accuracy of ultra-high frequency ultrasound (UHFUS) of labial salivary glands (LSGs) using both Grey Scale (GS) and colour Doppler (CD). We also investigated its role as an alternative to the highest-weighted classification criteria, its classification performance in combination with SSA status, its contribution to patient stratification and age-related classification variability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 270 patients with suspected Sj\u00f6gren\u2019s disease (SjD) (136 SjD, 134 Sicca) underwent UHFUS. In addition to OMERACT GS (modified to LSG), CD and composite GS+CD Scores, distinct GS morphological lesions were assessed. Diagnostic accuracy parameters were calculated, and additional analyses included correlation, logistic regression and cluster analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The optimal classification cut-off was GS \u22652, yielding 66.2% sensitivity and 84.3% specificity. GS Score 3 was highly specific (98.5%), while very hypoechoic areas were exclusively observed in SjD. CD \u22652 showed accuracy comparable to GS, and GS+CD \u22653 enhanced accuracy. Incorporating GS into the American College of Rheumatology\/European League Against Rheumatism criteria in place of biopsy achieved excellent accuracy (area under the curve 0.945). Using GS, GS+CD and SSA status, more than 75% of patients could be classified with an accuracy of 94%. Cluster analysis suggests different phenotypes: in Sicca, GS positivity indicated non-immune inflammatory alterations or sialoadenosis; in SjD, GS negativity defined low-grade inflammation. Classification accuracy of GS varied with age, whereas CD remained stable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>UHFUS of LSGs is a promising diagnostic tool in SjD when biopsy is not feasible. This study provides novel insights into GS lesions, Doppler assessment, phenotypes and age-related changes of ultrasound.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2026-006906","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:10:47Z","timestamp":1783084247000},"page":"e006906","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Ultra-high frequency ultrasound of labial salivary glands in Sj\u00f6gren\u2019s disease: diagnostic accuracy and patient stratification"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0130-4412","authenticated-orcid":false,"given":"Giovanni","family":"Fulvio","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy"},{"name":"Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossana","family":"Izzetti","sequence":"additional","affiliation":[{"name":"Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ferro","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"La Rocca","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy"},{"name":"Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Dei","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Fonzetti","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Leto","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Gulia","sequence":"additional","affiliation":[{"name":"Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Donati","sequence":"additional","affiliation":[{"name":"Unit of Pathological Anatomy 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5937-4574","authenticated-orcid":false,"given":"Marta","family":"Mosca","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Baldini","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, 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