eISSN: 2084-9834
ISSN: 0034-6233
Reumatologia/Rheumatology
Bieżący numer Archiwum Artykuły zaakceptowane O czasopiśmie Suplementy Rada naukowa Bazy indeksacyjne Prenumerata Kontakt Zasady publikacji prac
NOWOŚĆ
Portal dla reumatologów!
www.ereumatologia.pl
SCImago Journal & Country Rank
 
6/2019
vol. 57
 
Poleć ten artykuł:
Udostępnij:
więcej
 
 
List do Redakcji

Labial salivary gland biopsy and secondary Sjögren’s syndrome: where we are and where we want to be

Ciro Manzo
1

1.
Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic Hospital „Mariano Lauro”, Sant’Agnello, Italy
Data publikacji online: 2019/12/31
Plik artykułu:
- Labial - Manzo.pdf  [0.05 MB]
Pobierz cytowanie
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
 

Dear Editor,

I read with great interest the paper recently published by Sebastian et al., in which the authors summarized the previously used and current classification criteria for secondary Sjogren’s syndrome (sSS), and underlined “the need for labial salivary gland biopsy in all cases in which we suspect sSS to confirm the diagnosis” [1].

As is well known, labial salivary gland (LSG) biopsy is anything but easy and straightforward. Vivino et al. [2] reported that a second expert evaluation of 58 LSGs re-analyzed by a single center led to revision of the initial diagnosis in 53% of the patients. More recently, Costa et al. [3] reported a multicenter cohort study in which LSG biopsies were analyzed with a standard blinded assessment by two different pathologists at a 2-month interval. The analysis included the measurement of focus score (FS) and detection of germinal center (GC)-like structures. The inter-observer variability comparison revealed poor agreement for the detection and calculation of FS and detection of focal lymphocytic sialadenitis (FLS), lack of concordance for the presence of duct dilation and (less for) fibrosis. In more than 12% of the cases, the second evaluation by trained pathologists led to a diagnosis change [3].

In older patients, the presence of age-related findings may generate further confusion. For example, some investigators found that acinar atrophy and fibrosis are common in healthy individuals aged over 65 years, FS may be higher in older age groups, and the increased area of fat tissue may be a selective feature of aging [46].

More recently, the Sjögren’s histopathology workshop performed by the EULAR Sjögren’s Syndrome Experimental and Translational Investigative Alliance (ESSENTIAL) study group provided a consensus guidance for the use of LSG histopathology in clinical trials. The diagnostic importance of foci that are adjacent to normal parenchyma was emphasized and several recommendations were proposed. In particular, recommendation number 6 suggested that the extent of the atrophic features should be graded as mild, moderate, and severe, in addition to the presence or absence of FLS. Instead, recommendation number 10 underlined the necessity that all foci should be included in the FS and in foci calculations, even when adjacent to abnormal acini or ducts. However, the level of these recommendations was low [7].

As for today, there is still a strong need to achieve a consensus among experts on how to differentiate in LSG biopsy the Sjogren’s typical findings from the age-related ones [8]. The use of a grading score taking the destruction of acinar tissue and fibrosis into account could help (Table I).

Table I

Tarpley’s grading system for LSG biopsy [modified based on 9, 10]

GradeDescription of gland tissue
0Normal
11 or 2 aggregates
2> 3 aggregates
3Diffuse infiltrate with partial destruction of acinar tissue, with or without fibrosis
4Diffuse infiltrate (with or without fibrosis) destroying the entire lobular architecture

Furthermore, as recently highlighted by Mavragani and Moutsopoulos [10], immunohistochemical studies comparing the composition of lymphocytic infiltrates in LSG biopsy revealed differences almost exclusively in rheumatoid arthritis associated with sicca-related manifestations, and not in other systemic autoimmune rheumatic diseases associated with Sjögren’s syndrome.

Therefore, is LSG biopsy crucial to confirm the diagnosis of sSS? Not always. It often becomes itself an element of discussion or confusion.

Notes

[1] Conflicts of interest The author declares no conflict of interest.

References

1 

Sebastian A, Szachowicz A, Wiland P , authors. Classification criteria for secondary Sjögren’s syndrome. Current state of knowledge. Reumatologia. 2019. 57:p. 277–280

2 

Vivino FB, Gala I, Hermann GA , authors. Change in final diagnosis on second evaluation of labial minor salivary gland biopsies. J Rheumatol. 2002. 29:p. 938–944

3 

Costa S, Quintin-Roué I, Lesourd A, et al. , authors. Reliability of histopathological salivary gland biopsy assessment in Sjögren’s syndrome: a multicenter cohort study. Rheumatology (Oxford). 2015. 54:p. 1056–1064

4 

Radfar L, Kleiner DE, Fox PC, Pillemer SR , authors. Prevalence and clinical significance of lymphocytic foci in minor salivary glands of health volunteers. Arthritis Rheum. 2002. 47:p. 520–524

5 

Vered M, Buchner A, Boldon P, Dayan D , authors. Age-related histomorphometric changes in labial salivary glands with special reference to the acinar component. Exp Gerontol. 2000. 35:p. 1075–1084

6 

Leehan KM, Pezant NP, Rasmussen A, et al. , authors. Fatty infiltration of the minor salivary glands is a selective feature of aging but not Sjögren’s syndrome. . Autoimmunity. 2017. 50:p. 451–457

7 

Fisher BA, Jonsson R, Daniels T, et al. , authors. Standardization of labial salivary gland histopathology in clinical trials in primary Sjögren’s syndrome. Ann Rheum Dis. 2017. 76:p. 1161–1168

8 

Manzo C, Maslinska M , authors. Primary Sjögren’s syndrome in the elderly: does age of onset make a difference? EMJ Rheumatol. 2018. 5:p. 75–82

9 

Tarpley TM Jr, Anderson LG, White CL , authors. Minor salivary gland involvement in Sjögren’s syndrome. Oral Surg Oral Med Oral Pathol. 1974. 37:p. 64–74

10 

Mavragani CP, Moutsopoulos HM , authors. Primary versus secondary Sjögren syndrome: is it time to reconsider these terms? J Rheumatol. 2019. 46:p. 665–666

Copyright: © 2019 Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
 
facebook linkedin twitter
© 2020 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe