Labial salivary gland biopsy in the diagnosis of Sjögren’s syndrome
DOI:
https://doi.org/10.15584/ejcem.2019.2.10Keywords:
biopsy, labial glands, salivary glands, Sjögren’s syndromeAbstract
Introduction. Labial salivary gland biopsy is used for diagnosis of Sjögren’s syndrome (SS) and lymphoma accompanying SS.
Aim. The aim of this study was to present the main techniques used for taking labial salivary gland biopsies in the diagnosis of SS with respect to their advantages, histologic criteria, validation, complications, and their usefulness for diagnostic procedures, monitoring disease progression, and treatment evaluation.
Material and methods. This study is based on analysis of literature.
Results. The microscopic confirmation of SS is based on the presence of focal lymphocytic sialadenitis (FLS) with a focus score ≥1 per 4 mm2 of glandular tissue. A lymphocytic focus is defined as a dense aggregate of 50 or more lymphocytes adjacent to normal-appearing mucous acini in salivary gland lobules that lacked ductal dilatation. Other histopathological features of SS are lymphoepithelial lesions and a relative decrease of <70% IgA + plasma cells. Labial salivary gland biopsy is characterized by high specificity, a positive predictive value, and an average sensitivity of 79% in SS.
Conclusion. It can be also valuable in diagnosing B-cell mucosa-associated lymphoid tissue (MALT) lymphomas but it is not recommended for the monitoring of SS progression and the effectiveness of the treatment. Persistent lower lip hypoesthesia is the most severe complication of labial salivary gland biopsy.
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Caporali R, Bonacci E, Epis O, Bobbio-Pallavicini F, Morbini P, Montecucco C. Safety and usefulness of minor salivary gland biopsy: retrospective analysis of 502 procedures performed at a single center. Arthritis Rheum. 2008;59:714-720.
Shiboski CH, Shiboski SC, le Seror R, et al. Classification Criteria for Primary Sjögren’s Syndrome. A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Ann Rheum Dis. 2017;76(1):9-16.
Franceschini F, Cavazzana I, Andreoli L, Tincani A. The 2016 classification criteria for primary Sjogren’s syndrome: what’s new? BMC Medicine. 2017;15:69.
Błochowiak KJ, Trzybulska D, Olewicz-Gawlik A, et al. Levels of EGF and VEGF in patients with primary and secondary Sjögrn’s syndrome. Adv Clin Exp Med. 2018;27(4):455-461.
Błochowiak KJ, Olewicz-Gawlik A, Trzybulska D, et al. Serum ICAM-1, VCAM-1 and E-selectin levels in patients with primary and secondary Sjögren’s syndrome. Adv Clin Exp Med. 2017;26(5):835-842.
Błochowiak K, Olewicz-Gawlik A, Polańska A, et al. Oral mucosal manifestations in primary and secondary Sjögren syndrome and dry mouth syndrome. Adv Dermatol Allergol. 2016;33(1):23-27.
Olewicz-Gawlik A, Polańska A, Trzybulska D, et al. Skin barrier function in patients with primary and secondary Sjögren’s syndrome. Acta Dermatovenerol Croat. 2018;26(2):153-156.
Guellec D, Cornec D, Jousse-Joulin S, et al. Diagnostic value of labial minor salivary gland biopsy for Sjögren’s syndrome: A systematic review. Autoimmunity Reviews. 2013;12(3):416-420.
Fuglewicz A, Pękala Ł. Secondary Sjögren’s syndrome in patients with systemic connective tissue diseases. Adv Clin Exp Med. 2003;12(3):329–339.
Wardas P, Piotrowska-Seweryn A, Sokołowski M, Dorosz R, Markowski J. Sjögren’s syndrome and tuberculosis – case report and literature review. Otorynolaryngologia. 2014,13:176-181.
Wang SQ, Wang YX, Hua H. Characteristics of labial gland mesenchymal stem cells of healthy individuals and patients with Sjögren’s syndrome: a preliminary study. Stem Cell Develop. 2017;26:1171-1185.
Vitali C, Bombardieri S, Jonsson R. Classification criteria for Sjögren’s syndrome. A revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61(6):554-558.
Hernández-Molina G, Avila-Casado C, Nuñez-Alvarez C. Utility of the Americam-European Consensus Group and Americanan College of Rheumatology Classification Criteria for Sjögren's ’yndrome in patients with systemic autoimmune diseases in the clinical setting. Rheumatology. 2015;54(3):441-448.
Shiboski CH, Shiboski SC, Seror R. 2016 America College of Rheumatology/European League Against Rheumatism Classification Criteria for primary Sjögren’s syndrome. Arthritis Rheumatol. 2017;69(1):35-45.
Kim J, Sun D, Ozl R, et al. A validated method of labial minor salivary gland biopsy for the diagnosis of Sjögren’s syndrome. Laryngoscope. 2016; 126(9):2041-2046.
Fox RI. Sjögren’s syndrome. Lancet. 2005;366(9482):321-331.
Tarpley TM Jr, Anderson LG, White CL. Minor salivary gland involvement in Sjögren’s syndrome. Oral Surg Oral Med Oral Pathol. 1974;37(1):64-74.
Chisholm DM, Mason DK. Labial salivary gland biopsy in Sjögren's disease. J Clin Pathol. 1968;21(5):656-660.
Kroese F, Haacke E, Bombardieri M. The role of salivary gland histopathology in primary Sjögren’s syndrome: promises and pitfalls. Clin Exp Rheumatol. 2018;36, 112(3):222-233.
Fox RI. Standardisation of labial salivary gland biopsies in Sjögren’s syndrome. Ann Rheum Dis. 2017;76(7):1159-1160.
Fisher BA, Jonsson R, Daniels, et al. Standardisation of labial salivary gland histopathology in clinical trials in primary Sjögren’s syndrome. Ann Rheum Dis. 2017;76(7):1161-1168.
Sarioğlu S, Küҫük Ŭ, Cetin P, Sari I, Bĭrlĭk AM. Minor salivary gland evaluation: Sjögren’s syndrome. Turk J Med Sci. 2016;46:63-65.
Varela-Centelles P, Sanchez-Sanchez M, Seoane J. Lip biopsy for the diagnosis of Sjögren’s syndrome: beware of the punch. Int J Oral Maxillofac Surg. 2014;43(1):127-130.
Giovelli RA, Santos MCS, Serrano E, Valim V. Clinical characteristics and biopsy accuracy in suspected cases of Sjögren’s syndrome referred to labial salivary gland biopsy. BMC Musculoskeletal Disorders. 2015;16:30.
Delli K, Vissink A, Spijkervet FKL. Salivary gland biopsy for Sjögren’s syndrome. Oral Maxillofac Surg Clin North Am. 2014;26(1):23-33.
Bamba R, Sweiss NJ, Langerman AJ, Taxy JB, Blair EA. The minor salivary gland biopsy as a diagnostic tool for Sjögren’s syndrome. Laryngoscope. 2009; 119:1922-1926.
Langerman AJ, Blair EA, Sweiss NJ, Taxy JB. Utility of lip biopsy in the diagnosis and treatment of Sjögren’s syndrome. Laryngoscope. 2007;117(6):1004-1008.
Van Stein-Callenfels, Tan J, Bloemena E, van Vugt RM, Voskuyl AE, Santana NT, van der Waal I. The role of labial salivary gland biopsy in the diagnostic procedure for Sjögren’s syndrome; a study of 94 cases. Med Oral Patol Oral Cir Bucal. 2014;19(4):e372-376.
Haacke E, Bootsma H, Spijkervet FKL, et al. FcRL4+ B-cells in salivary glands of primary Sjögren’s syndrome patients. J Autoimmun. 2017,81:90-98.
Yokogawa N, Lieberman SM, Alawi F, et al. Comparison of labial minor salivary gland biopsies from childhood Sjögren syndrome and age-matched controls. J Rheumatol. 2014;41(6):1178-1182.
Gorson KC, Ropper AH. Positive salivary gland biopsy, Sjögren’s syndrome and neuropathy: clinical implications. Muscle Nerve. 2003;28(5):553-560.
Berquin K, Mahy P, Weynand B, Reychler H. Accessory or sublingual salivary gland biopsy to assess systemic disease: a comparative retrospective study. Eur Arch Otorhinolaryngol. 2006; 26:233-236.
Saruhanoğlu A, Atikler M, Ergun S, Ofluoğlu D, Tanyeri H. Comparison of two different labial salivary gland biopsy incision techniques: A randomized clinical trial Med Oral Patol Oral Cir Bucal. 2013;18(6):e851–e855.
Collela G, Canavale R, Vicidomini A, Intro A. Salivary gland biopsy: a comprehensive review of techniques and related complications. Rheumatology. 2010;49(11):2117-2121.
Fragoulis GE, Fragkioudaki S, Reilly JH, Kerr SC, McInnes IB, Mautsopoulos HM. Analysis of the cell populations composing the mononuclear cell infiltrates in the labial minor salivary glands from patients with rheumatoid arthritis and sicca syndrome. J Autoimmun. 2016;73:85-91.
Soyfoo MS, Catteau X, Delporte C. Parotid gland biopsy as an additional diagnostic tool for supporting the diagnosis of Sjögren’s syndrome. Int J Rheumatol. 2011:302527.
Pijpe J, Kalk WWI, van der Wal JE, et al. Parotid gland biopsy compared with labial biopsy in the diagnosis of patients with primary Sjögren’s syndrome. Rheumatology. 2007;46(10):335-341.
de Sousa Gomes P, Juodzbalys G, Fernandes MH, Guobis Z. Diagnostic Approaches to Sjögren's syndrome: a Literature Review and Own Clinical Experience. J Oral Maxillofac Res. 2012;3(1):e3.
Błochowiak K, Wyganowska-Światkowska M. Labial minor salivary gland biopsy in the diagnosis of Sjögren syndrome-own experience. Dent Forum. 2018;46(2):17-21.
Scardina GA, Spanó G, Carini F, et al. Diagnostic evaluation of serial sections of labial salivary gland biopsies in Sjögren’s syndrome. Med Oral Pathol Oral. 2007;12:565-568.
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