Safety and usefulness of minor salivary gland biopsy: Retrospective analysis of 502 procedures performed at a single center

Abstract

Objective. To analyze the safety of our biopsy technique and the effectiveness of minor salivary gland biopsy (MSGB) for the diagnosis of Sjö gren's syndrome (SS) and amyloidosis. Methods. We conducted a retrospective analysis of 452 patients with suspected SS and 50 with suspected amyloidosis and negative periumbilical fat aspiration analysis who underwent MSGB at a single center. Diagnostic evaluation for SS included Schirmer's test, unstimulated whole salivary flow, detection of antinuclear antibodies and anti-SSA/SSB, erythrocyte sedimentation rate, C-reactive protein, IgM rheumatoid factor, and serology for hepatitis C virus. For all biopsy samples, a cumulative focus score on multilevel sections was calculated. SS was diagnosed according to American-European Consensus Group (AECG) criteria. Histologic evaluation for amyloidosis was performed using Congo red staining and polarized-light microscopy. Adverse events were recorded on a questionnaire immediately after the procedure and 7 days, 14 days, and 6 months thereafter. Results. Sixty-four patients (12.7%) reported transient adverse events: 40 paresthesias lasting <7 days, 17 paresthesias lasting <14 days, 27 cases of local swelling, and 8 external hematoma. One patient has had local paresthesia for 2 years. A total of 498 (99.2%) samples provided adequate material for histologic analysis. Of 452 patients evaluated for SS, 378 were finally evaluated. Ninety-three patients (24.5%) had a cumulative focus score >1, and 87 (94.5%) of 93 satisfied the AECG criteria. Classification of SS was possible for 124 (32.8%) of 378 patients. In 51 (41%) of 124, MSGB was essential to reach the number of criteria needed for classification. Of 50 patients evaluated for amyloidosis, 10 (20%) had positive Congo red staining. Conclusion. MSGB is a simple, safe, and reliable tool for the diagnosis of SS and amyloidosis, and therefore is suitable for more extensive application.

Localized Tongue Amyloidosis in a Patient with Neurofibromatosis Type II

“…Although the tongue is the most common oral site [6,10,[30][31][32], cases of amyloid deposition in the palate [11,33,34], maxillary vestibule [35], gingival [9] and floor of the mouth [36] have been mentioned as well. Rarely, minor or major salivary glands infiltration and related hypofuctionxerostomia can be seen [37][38][39]. Noteworthy, oral involvement is extremely rare as the localized solitary manifestation of amyloidosis, but when present the tongue is primarily affected [6,[8][9][10][11][12].…”

The importance of minor salivary gland biopsy in sjögren syndrome diagnosis and the clinicopathological correlation

“…SS is a significant disease that is more commonly seen in females (F/m: 9/1) and in the 4th and 5th decades (4,9,11,13). Females made up 93% of the cases in our study and the mean age was 53 years.…”

“…Caporali et al found the ratio of biopsies with at least one lymphoid focus to be 24.5% in their study including 435 patients (11). The ratio of the biopsies with a focus score of ≥ 1 was found to be 42.7% among 120 biopsies in another study conducted by morbini et al (12).…”

Dental perspective on Sjögren’s syndrome: literature review

“…Minor salivary gland biopsy: The minor salivary gland biopsy is a simple procedure carried out by a dentist, which now is widely used in internal medicine and rheumatology for the diagnosis of SS 40 and other infiltrative diseases of connective tissue, such as amyloidosis, hemochromatosis, and sarcoidosis 41 . Although it is a simple procedure, some side effects and disadvantages of this diagnostic technique have been reported, such as pain, salivary duct trauma 14 , infection, loss of sensation and development of granulomas 42 .…”