Minor salivary gland biopsy—an important contributor to the diagnosis of Sjogren’s syndrome

Publication date: Available online 30 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Sarah Wicheta, Troy Van der Groen, William C. Faquin, Meredith August
PurposeSjogren's syndrome (SS), though commonly associated with xerostomia and xerophthalmia, may present with extraglandular manifestations that make definitive diagnosis difficult. The two leading diagnostic classification systems both include a positive minor salivary gland biopsy (MSGB) as a major inclusion criteria.¹ Our purpose is to better define the role of the MSGB in establishing a diagnosis of SS in a cohort of referred patients.MethodsThis is a retrospective cohort study of patients referred to the Massachusetts General Hospital (MGH) Department of Oral and Maxillofacial Surgery (OMS) over a 5 year period to establish a diagnosis of SS. Inclusion criteria were: complete information regarding presenting symptoms, reason for referral and findings on MSGB. Incomplete records and referral for reasons other than presumptive SS resulted in exclusion. The MSGB and its role in definitive diagnosis based on accepted classification systems is evaluated for sensitivity, specificity and positive and negative predictive value. Other variables of interest (demographics, pattern of referral and symptomology) are described for the cohort.ResultsA total of eighty- seven patients met inclusion criteria. The mean age was 48.3 years (range 19-74 years) and 75 (86.2%) were female. Fifteen MSGB (17.2%) were positive based on the focus score (FS) histologic criteria.² In 12/15 cases, it was the positive MSGB that allowed for definitive diagnosis (80%). In 3 cases, other criteria allowed diagnosis without the contribution of the MSGB. (Sensitivity of MSGB=80.0%; Specificity=87.5%; Positive Predictive Value=57.1%; Negative Predictive Value=95.5%)ConclusionThe MSGB is an important contributor to a diagnosis of SS. When serology was negative, the MSGB was often the criterion that allowed the diagnosis to be established. It is the most frequently positive of the major criteria employed by both classification systems in current use.



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