Discrepancies in Interpretation of the Minor Salivary Gland Biopsy in the Diagnosis of Sjögren syndrome

Publication date: Available online 8 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Sarah Wicheta, Troy Van der Groen, William C. Faquin, Meredith August

Purpose

Although the minor salivary gland biopsy(MSGB) is a major criterion for diagnosis of Sjögren syndrome(SS), multiple studies have outlined difficulties in standardization.1, 2 The purpose of this study was to answer the following question: In all patients referred for MSGB, did strict application of focus scoring criteria alter the sensitivity of and predictive value of the MSGB in the diagnosis of SS when compared to the initial interpretation?

Materials and Methods

We designed a cross-sectional study of patients referred to the Massachusetts General Hospital Department of OMS over a 5-year period for MSGB. The primary predictor variable was the MSGB focus score. The primary outcome variable was the SS diagnosis. The newly established SS diagnosis status results were then compared to the initial SS diagnoses. Sensitivity, specificity and positive and negative predictive values were calculated. Other relevant variables of interest, such as size of glandular tissue harvested and associated signs and symptoms, were also described.

The primary predictor variable was the MSGB focus score the primary outcome variable was the SS diagnosis (positive or negative).

Results

Seventy-three patients met inclusion criteria. The mean age was 48.5 years (range, 19-71yrs) and 64 were female (87.6%). Our previous study utilizing initial pathology reports yielded 80.0% sensitivity, 87.5% specificity, PPV=57.1% and NPV= 95.5%. The current review of the MSGB using strict focus scoring guidelines yielded: 95.4% sensitivity, 76.4% specificity, PPV=63.6% and NPV=97.5%.

Conclusion

The MSGB is an important major criterion in establishing a diagnosis of SS. Application of strict focus scoring guidelines when reviewing the MSGB yielded a sensitivity far greater than initially reported in this group. Difficulties with interpretation are discussed. Future studies will focus on improvement of interpretation and immunohistochemical aids in diagnosis.

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