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Labial salivary gland biopsy useful in diagnosis of Sjögren’s syndrome
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Biopsy of the labial salivary gland showed high sensibility and specificity with positive and negative predictive values for obtaining a diagnosis of primary Sjögren’s syndrome, according to researchers in Brazil.
The researchers retrospectively reviewed the histopathological reports and medical report data of 183 patients who presented with low unstimulated salivary flow and other symptoms of dryness at the Rheumatology Unit of the University Hospital of the Federal University of Espírito Santo. Demographic information, symptoms and comorbidities were recorded, and antinuclear antibodies (ANA), rheumatoid factor (RF), anti-Sjögren's-syndrome-related antigen A (anti-SSA-Ro) and anti-Sjögren's-syndrome-related antigen B (anti-SSB-La) were measured through laboratory tests.
Patients were diagnosed with Sjögren’s syndrome (SS) according to the American-European Consensus Group (AECG) criteria and the treating specialist’s opinion.
After diagnosis, patients underwent labial salivary gland biopsy (LSGB) and another specialist evaluated the patient data and LSGB for sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV). Concordance between the two diagnoses was calculated using the Kappa coefficient.
The accuracy of the first diagnosis of primary SS was evaluated in 183 patients. Biopsies were positive in 61 patients, 58 of whom had a positive diagnosis, and biopsies were negative in 122 patients, 113 of whom had a negative diagnosis.
The level of sensibility was calculated to be 86.57% and specificity of the test was 97.43%, according to the researchers. Additionally, the PPV was 95% and NPV was 92.6%, yielding an accuracy level of 93.3%.
Patients with a diagnosis of primary SS were older, had higher symptom severity and systemic manifestations, were more likely to have positive antibody tests and had fibromyalgia as the most common comorbidity. Only 2.3% of all patients with SS tested positive for any antinuclear antibodies and failed to fulfill AECG criteria. Two of the five patients showed LSGB focus scores of one or greater and a diagnosis by the specialist, and three had positive biopsy results.
When classified with AECG criteria alone, concordance was high, but lower than diagnosis from the specialist. In 67.6% of patients with SS, LSGB was required to meet AECG criteria. – by Shirley Pulawski
Disclosure:The researchers report no relevant financial disclosures.
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