Main elements of the intended lecture.
After history taking and physical examination, additional investigations may be helpful to confirm a tentative diagnosis or to rule out other diagnoses. Additional investigation(s) should meet with the following conditions: it should give additive information to the information already available, it should be discriminative and the outcome should have therapeutic consequences. Participation in studies on clinical or translational scientific issues may also require additional investigations to complete classification and/or inclusion criteria.
Salivary gland biopsy may be indicated to confirm a presumptive diagnosis of primary Sjögren's syndrome (pSS) and other conditions causing dryness and/or salivary gland enlargement including IgG4 related disease and sarcoidosis. Labial salivary gland biopsy, which is to be performed easily by a rheumatologist, is widely considered and used as the single most specific test for confirming a diagnosis of pSS. In clinical practice, the main histo-pathological findings in salivary glands of pSS patients include focal sialo-adenitis and an increase of IgG and IgM containing plasma cells.
New techniques are reported to be less invasive, without loss of information.
Technical procedures, limitations and complications will be summarized.
Despite impressive scientific progress in understanding the roles of T and B cell subsets in ongoing inflammation in salivary tissue in pSS, the natural evolution of this inflammation is largely unknown.
For clinical practice, however, novel insights may influence daily clinical practice directly. For instance, in children, modest focal sialadenitis, also with a focusscore <1, is recently reported to be indicative for pSS. In adult pSS patients, the role of ectopic germinal centers, present in 25% of pSS salivary glands, in predicting more sever disease including the development of lymphoma is emphasized. Also, routine salivary gland assessment is reported to be of prognostic value: a focus score ≥3 has a positive predictive value for enhanced systemic disease and the development of lymphoma.
Key messages to share
How to use labial salivary gland biopsy in diagnosis and classification of pSS.
Labial salivary gland biopsy is to be performed easily by a rheumatologist.
Routine assessments are of prognostic value.
Disclosure of Interest None declared