Background Sjögren's syndrome (SS) is a disease with a wide spectrum of clinical manifestations which can make diagnosis difficult. Due to difficult diagnosis the Americo-European classification criteria (AECC) are used. The positivity of antibodies or histology are essential to comply with these criteria, forcing in certain situations, especially in cases with negative immunology, to carry out a lip biopsy.
Objectives To evaluate the diagnostic utility of the minimally invasive biopsy of the minor salivary gland.
Methods Transversal study of 159 biopsies of the minor salivary gland. Inclusion Criteria: patients with dry syndrome. Biopsy Technique: vertical incision (≤5 mm) of the internal surface of the lower lip whithout suturing. Variables studied: 1) Clinical: age, sex, presence and duration of the symptoms. 2) Diagnostic: The necessary examinations were performed to fulfill the AECC: Schirmer, salivary scintigraphy, ANA, RF, Ab-SSA and Ab-SSB. 3) Histological: a) degree of atrophy: absent, mild, moderate and severe; b) Chisholm-Mason scale (I-IV) considering as positive biopsy grade III or IV; c) degree of lymphocyte infiltration: absent, mild, moderate, severe; d) histological patterns: normal, nonspecific chronic sialadenitis (NSCS), sclerosing chronic sialadenitis (SCS), focal lymphocytic sialadenitis (FLS)
Results The characteristics of the sample group were; age 59.9 ±12.43 years, 91% women, 88% xerostomia, 89% xerophthalmia for a period of 49±37 months, 45% positive salivary scintigraphy, 54% positive Schirmer, 54% AAN, RF 22%, Ab-Ro and Ab-La of 28% and 6.2% respectively. Appropriate material was obtained for histological study in 92.5%, being more frequent in older patients (60 ± 53 vs 12.2 ± 12.8; p<0.05). Analyzing the data after the biopsy, 16% (n=22) of patients met diagnostic criteria. Depending on the number of previous classificatory criteria 22% and 26% of patients met 3 and 4 criteria, respectively, were diagnosed of SS. Glandular atrophy was observed in 65% (n=95) with the following distribution: mild 38%, moderate 23%, severe 4%. The histological degree of atrophy was related to patient age (r =0.38; p<0.0001). Chisholm-Mason scale classified biopsies as normal (n=22; 15%), grade I (n=73; 50%), grade II (n=15; 10%), grade III (n=22; 15%) and grade IV (n=15; 10%), being biopsies positive in 25%. The most frequent histopathological pattern was NSCS (n=83; 57%), followed by FLS (n=37; 25%), normal (n=22; 15%) and SCS (n=5; 3%). Lymphocytic sialadenitis was observed in 85% (n=125; 47% mild, moderate 18%, severe 20%) but only 25% (n=37) presented the focal lymphocytic infiltration characteristic of SS. The positive biopsy was related to the positivity of Ab-Ro (40% vs. 22%; p<0.0352), Ab -La (10% vs 1%, p<0.0002), RF (35% vs. 18%; p<0.03) and ANA (70% vs 46%;. p<0.01) There was no difference between age and the different histological patterns, but SCS was more likely in patients with more advanced age
Conclusions The minimally invasive biopsy of the minor salivary gland, could be currently considered essential for the diagnosis of SS, especially in patients who meet ≥3 criteria.
Disclosure of Interest None declared