Background The minor salivary gland biopsy (MSGB) plays a preponderant role in the American European Consensus Group (AECG) criteria set for primary and secondary Sjögren’s syndrome (SS).However, its diagnostic value remains partially unclear and some authors have pointed out the lack of reproducibility of the results, and the lack of specificity of the test.
Objectives To estimate the diagnostic value of MSGB for primary-SS, we performed a systematic review of published studies on MSGB for investigating SS.
Methods PUBMED and EMBASE databases were searched. The following association of MeSh terms was used: “SJOGREN’S SYNDROME” in conjunction with “SALIVARY GLANDS” AND “BIOPSY”. All publications published between January 1966 and June 2011 were considered. Selected publications were screened for additional relevant studies. We selected studies that considered a Focus Score (FS) ≥1 (or equivalent) as cut-off for a positive biopsy and concerning patients addressed for suspected SS. Sensibility and specificity of MSGB were collected, or calculated when possible.
Results From the 237 publications identified, 8 were finally included in the study (table 1). Among these 8 studies, sensitivity ranged from 63.5% to 93.7% and specificity from 61.2% to 100%. Specificity was >89% in 6 studies (Table 1).
The differentiation between SS and non-SS patients was made without the help of MSGB or through a clinical reevaluation in only 2 studies. In these studies, sensitivity was respectively 63.9% and 85.7%, specificity was 91.9% and 89.7%. These 2 studies concerned 73 and 120 patients, evaluated for sicca symptoms in the first case and suspicion of primary-SS in the second. The gold standard for diagnosis of primary-SS was a set of criteria that did not include the MSGB in the first case and a reassessment of each patient by three experienced rheumatologists in the second (but not blinded to the MSGB).
Conclusions Few studies are available in the literature to estimate the diagnostic value of MSGB for primary-SS. Only 2 studies used a methodology that avoids circular reasoning. Our study shows the lack of knowledge about the diagnostic value of MSGB, but confirm the good diagnosis value. The specificity of the test seems to be high, but the data about sensitivity is more heterogeneous.
Disclosure of Interest None Declared
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