Background Minor salivary gland biopsy (MSGB) is a minimally invasive accessible technique used for diagnosis (dx) of Sjögren's syndrome (SS) and other infiltrative diseases such as amyloidosis and sarcoidosis. According to the American-European Consensus Group criteria (2002) the presence of a support MSGB and/or the anti-SSA and anti-SSB antibodies is required for the diagnosis of SS. The presence of lymphocytic sialadenitis with focus ≥1 (≥50 cells) by 4 mm2 is considered a SS histological criteria
Objectives 1.To estimate the diagnostic yield of MSGB for evaluation of sicca syndrome (SSy) and confirmation of dx of SS in routine clinical practice. 2. To investigate the presence of correlation of histopathological alterations with clinical and immunological parameters
Methods Demographic data (age, sex), time tracking, MSGB indication, presence of rheumatoid factor (RF), antinuclear antibodies (ANA), IgG polyclonal hypergammaglobulinemia (hiperIgG), erythrocyte sedimentation rate (ESR), pre- and post-biopsy diagnosis and histopathology results were retrospectively collected, of 100 samples MSGB performed consecutively in Rheumatology consultation at our hospital from January 2012 to October 2014. Also a comparison between different variables (FR +, elevated ESR, ANA + and hiperIgG) with the result of the biopsy was performed by Chi-square test statistic.
Results Most patients were female (95%) with a mean age of 54.26 years (SD ±10.21) and a mean follow-up of 12.94 months (SD ±13.27). In 85% of cases, the MSGB was asked to study SSy, 12% for histological confirmation in patients with SS dx set, and the remaining 3% (no SSe) for fibromyalgia syndrome with immunological study (IS) positive (+); presence IS + and inflammatory arthralgia; and polyarthritis and IS + respectively. 26% of patients had FR +, 74% ANA + (23 patient's anti-SSA, 4 anti-SSA and anti-SSB and 1 patient anti-SSB). 7% had hiperIgG. 36% of biopsies met histopathological criteria of SS, 6% were compatible but did not present with typical features of SS, 25% showed nonspecific inflammation and 33% were normal. The biopsy confirmed the dx in 8/12 (66%) patients who already had the dx of SS and the dx of SS was provided in 20.24% of patients without previous dx (23/78). In 5 cases, the positive biopsy result did not change the dx. Of all patients with diagnostic biopsy of SS, 11.56% had FR +, 26.64% ANA +, 5.4% elevated ESR and 2.68% hiperIgG. No significant differences were found with respect to patients with these variables and MSGB was not diagnostic (14.44% [p =0.831], 47.36% [p =0.518], 4.32% [0.796] and 9.6% [p =0.35], respectively.
Conclusions The MSGB provides high returns for dx of SS in the evaluation of patients with SSy in routine clinical practice. In this series we didn't find correlation between the studied parameters and histopathological changes, which gives this minimally invasive and relatively simple technique possible in the consultation by the rheumatologist, a high value added per se. However, it would be appropriate to conduct a prospective study to confirm these results.
Disclosure of Interest None declared