PMID- 30836075
OWN - NLM
STAT- MEDLINE
DCOM- 20200807
LR  - 20200807
IS  - 1531-5053 (Electronic)
IS  - 0278-2391 (Linking)
VI  - 77
IP  - 8
DP  - 2019 Aug
TI  - Discrepancies in Interpretation of the Minor Salivary Gland Biopsy in the 
      Diagnosis of Sjogren Syndrome.
PG  - 1628-1635
LID - S0278-2391(19)30127-2 [pii]
LID - 10.1016/j.joms.2019.01.052 [doi]
AB  - PURPOSE: Although the minor salivary gland biopsy (MSGB) is a major criterion for 
      the diagnosis of Sjogren syndrome (SS), multiple studies have outlined 
      difficulties in standardization. The purpose of this study was to answer the 
      following question: in all patients referred for MSGB, did strict application of 
      focus scoring criteria alter the sensitivity of and predictive value of the MSGB 
      in the diagnosis of SS compared with the initial interpretation? MATERIALS AND 
      METHODS: The authors designed a cross-sectional study of patients referred to the 
      Massachusetts General Hospital Department of Oral and Maxillofacial Surgery 
      (Boston, MA) over a 5-year period for MSGB. The primary predictor variable was 
      the MSGB focus score. The primary outcome variable was the SS diagnosis. The 
      newly established SS diagnosis status results were compared with the initial SS 
      diagnoses. Sensitivity, specificity, and positive and negative predictive values 
      (PPV and NPV) were calculated. Other relevant variables of interest, such as size 
      of glandular tissue harvested and associated signs and symptoms, also were 
      documented. The primary predictor variable was the MSGB focus score and the 
      primary outcome variable was the SS diagnosis (positive or negative). RESULTS: 
      Seventy-three patients met the inclusion criteria. The mean age was 48.5 years 
      (range, 19 to 71 yr) and 64 were women (87.6%). The authors' previous study using 
      initial pathology reports yielded 80.0% sensitivity, 87.5% specificity, 57.1% 
      PPV, and 95.5% NPV. The present review of the MSGB using strict focus scoring 
      guidelines yielded 95.4% sensitivity, 76.4% specificity, 63.6% PPV, and 97.5% 
      NPV. CONCLUSIONS: The MSGB is an important major criterion in establishing a 
      diagnosis of SS. Application of strict focus scoring guidelines when reviewing 
      the MSGB yielded a sensitivity far greater than initially reported in this group. 
      Difficulties with interpretation are discussed. Future studies will focus on 
      improvement of interpretation and immunohistochemical aids in diagnosis.
CI  - Copyright (c) 2019 American Association of Oral and Maxillofacial Surgeons. 
      Published by Elsevier Inc. All rights reserved.
FAU - Wicheta, Sarah
AU  - Wicheta S
AD  - Predoctoral Student, Harvard School of Dental Medicine, Boston, MA.
FAU - Van der Groen, Troy
AU  - Van der Groen T
AD  - Resident, Portsmouth Naval Medical Center, Portsmouth, VA and Harvard School of 
      Dental Medicine, Boston, MA.
FAU - Faquin, William C
AU  - Faquin WC
AD  - Professor, Department of Head and Neck Pathology and Cytology, Massachusetts 
      General Hospital, Boston, MA.
FAU - August, Meredith
AU  - August M
AD  - Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts 
      General Hospital, Boston, MA. Electronic address: maugust@partners.org.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20190208
PL  - United States
TA  - J Oral Maxillofac Surg
JT  - Journal of oral and maxillofacial surgery : official journal of the American 
      Association of Oral and Maxillofacial Surgeons
JID - 8206428
SB  - IM
MH  - Adult
MH  - Aged
MH  - Biopsy
MH  - Cross-Sectional Studies
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - *Salivary Glands, Minor/pathology
MH  - *Sjogren's Syndrome/diagnosis
MH  - Young Adult
EDAT- 2019/03/06 06:00
MHDA- 2020/08/08 06:00
CRDT- 2019/03/06 06:00
PHST- 2018/11/07 00:00 [received]
PHST- 2019/01/31 00:00 [revised]
PHST- 2019/01/31 00:00 [accepted]
PHST- 2019/03/06 06:00 [pubmed]
PHST- 2020/08/08 06:00 [medline]
PHST- 2019/03/06 06:00 [entrez]
AID - S0278-2391(19)30127-2 [pii]
AID - 10.1016/j.joms.2019.01.052 [doi]
PST - ppublish
SO  - J Oral Maxillofac Surg. 2019 Aug;77(8):1628-1635. doi: 
      10.1016/j.joms.2019.01.052. Epub 2019 Feb 8.