A follow-up study of minimally invasive lip biopsy in the diagnosis of Sjögren’s syndrome

Abstract

The aims of this study were to characterize a minimally invasive technique of minor salivary gland biopsy of the lower lip and to present a large patient material undergoing this procedure because of a suspicion of Sjögren's syndrome (SS), as well as to assess the procedure's short-term and long-term value as a diagnostic test and a prognostic factor. The sample consists of consecutive 191 patients undergoing lower lip biopsy in 1987-1990 in Kanta-Hame Central Hospital, Hameenlinna, Finland. The method used was the retrospective chart review. Only three (1.6%) of the biopsies were uninformative, and only one (0.5%) of the patients had a biopsy complication. In 41% of the cases, biopsy was suggestive of SS. Females and elderly patients were more likely to have a positive biopsy result. Surprisingly, a large diversity between pathologists was observed. With the use of focus score instead of older Chisholm classification as an indicator of SS, the specificity of SS diagnostics improved, and the variability between pathologists diminished. Neither SS diagnosis nor positive lip biopsy for SS predicted patients' long-term outcome. In only three patients (1.6%) did the histological diagnosis change due to repeated biopsies. The minimal invasive lower lip biopsy technique presented in this study is a reliable and safe aid in SS diagnostics. The currently recommended histological grading system (focus score > or = 1 suggesting SS) is more specific and reproducible than older Chisholm classification. Repeated biopsy very rarely adds new information.

Minor salivary gland biopsy in Sjogren’s syndrome: A review and introduction of a new tool to ease the procedure

“…However, this instrument was originally designed for ophthalmology and has a number of shortcomings for oral use: the handles of the chalazion forceps are small-sized to allow finger control and are placed perpendicular to the main axis of the blades; this forces the assistant’s hand to work on an uncomfortable position, too near to the surgical field. The size of the fenestration also limits the incision design, particularly when undertaking minimally invasive techniques with multiple 2 mm incisions along the inner face of the lower lip (13,18,19). An improved chalazion forceps was introduced by López-Jornet et al (21): this forceps was larger than the original (20 cm.)…”

A Convenient and Less Invasive Technique of Labial Minor Salivary Gland Biopsy Using a Minimal Incision With a Needle Tip

“…It made an elliptical incision of oral mucous membrane down to the muscle layer [9]. After that, many modifications in a type or length of incision were reported [3,4,10,11,12,13,14,15,16,17,18,19,20,21,22]. The minor salivary gland punch biopsy was introduced in 2001 [17].…”

Comparison of two different labial salivary gland biopsy incision techniques: A randomized clinical trial

“…The size of the incision was reported in the range of 2-30 mm in length in previous studies (4). Some authors suggested that shorter incisions are more advantageous (2,6,18) because of less complications, whereas others suggested LSGB’s with longer incision techniques to supply sufficient tissue for exact diagnosis (3,15). Teppo and Revonta reported a minimally invasive method in which 3-4 mm horizontal incisions were performed.…”

“…Teppo and Revonta reported a minimally invasive method in which 3-4 mm horizontal incisions were performed. Among the 191 biopsies that they performed, 3 (1.6%) were considered to have failed due to scarce or non-existent salivary gland tissues in the specimens (18). We performed straight 10 mm incisions in the present study due to our previous clinical experiences which showed that LSGBs with 10 mm incision length revealed less complication rates and adequate number of samples.…”

“…Only a few studies reported surgical complications such as pyogenic granuloma formation in the area of the incision, external hematoma, local swelling, local infection, internal scarring, local pain, minor bleeding as well as vagal reaction (1,2,5,16,18). …”