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Olsson P, Ekblad F, Hassler A, Bengtsson M, Warfvinge G, Mandl T, Kvarnström M. Complications after minor salivary gland biopsy: a retrospective study of 630 patients from two Swedish centres. Scand J Rheumatol 2023; 52:208-216. [PMID: 35049421 DOI: 10.1080/03009742.2021.1999671] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aims of the study were to investigate the prevalence of impaired sensation after minor salivary gland biopsy (MSGB) in two Swedish centres [Karolinska University Hospital (KUH) and Skåne University Hospital (SUH)] and to assess its impact on quality of life (QoL) and associated risk factors. METHOD A questionnaire including questions regarding the presence of impaired sensation, impact on QoL, and impact on everyday life was sent to patients who had undergone MSGB between 2007 and 2016, and their medical notes were scrutinized. RESULTS The study included 630 patients (505 from KUH and 125 from SUH). In KUH the biopsies were performed by rheumatologists and in SUH by dentists or oral and maxillofacial surgeons (OMSs). Long-standing, probably permanent, impaired sensation after MSGB was reported by 21% of patients, and was associated with lower age and absence of anti-SSA antibodies. Patients with long-standing impaired sensation reported the inconvenience (1-10) of impaired sensation as 4.0 (2.0-7.0) [median (interquartile range)], and 32% reported an influence on their QoL, the reported influence (1-10) on everyday life being 3.0 (1.0-5.0). When comparing the outcomes from KUH and SUH, patients from SUH reported a significantly lower frequency of long-standing impaired sensation (14% vs 23%; p = 0.02). CONCLUSION A high frequency of long-standing impaired sensation after MSGB was found among patients who had undergone MSGB, although it had a low impact on everyday life. The complication frequency was less pronounced when a dentist or an OMS had performed the biopsy.
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Affiliation(s)
- P Olsson
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Section of Rheumatology, Department of Medicine, Helsingborg Central Hospital, Sweden
| | - F Ekblad
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden
| | - A Hassler
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden
| | - M Bengtsson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Oral & Maxillofacial Surgery, Skåne University Hospital, Lund, Sweden
| | - G Warfvinge
- Department of Oral Biology and Pathology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - T Mandl
- Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden
| | - M Kvarnström
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Academic Specialist Center, Center for Rheumatology, Stockholm Health Services Region, Stockholm, Sweden
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Current Salivary Glands Biopsy Techniques: A Comprehensive Review. Healthcare (Basel) 2022; 10:healthcare10081537. [PMID: 36011194 PMCID: PMC9408798 DOI: 10.3390/healthcare10081537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Biopsy is a surgical procedure performed to collect a portion of tissue or organ for diagnostic studies. The aim of the present manuscript is to describe state-of-the-art major and minor salivary gland biopsy techniques and assess the indications and complications of other salivary gland biopsy techniques. A search was performed using the following MeSH terms: biopsy, fine-needle biopsies, image-guided biopsies, frozen sections, and salivary glands disease. A current overview of major and minor salivary glands biopsy techniques was provided. In the oncological field, a comparison was made between the most widely used biopsy method, ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and an alternative method, ultrasound-guided core needle biopsy (US-guided CNB), highlighting the advantages and disadvantages of each. Finally, intra-operative frozen sections (IOFSs) were presented as an additional intraoperative diagnostic method. Minor salivary gland biopsy (MSGB) is the simplest diagnostic method used by clinicians in the diagnosis of inflammatory and autoimmune diseases. In neoplastic lesions, US-FNAB represents the most performed method; however, due to its low diagnostic accuracy for non-neoplastic specimens, US-guided CNB has been introduced as an alternative method.
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Valdez RMA, Melo TS, Santos-Silva AR, Duarte A, Gueiros LA. Adverse post-operative events of salivary gland biopsies: A systematic review and meta-analysis. J Oral Pathol Med 2021; 51:152-159. [PMID: 34363247 DOI: 10.1111/jop.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study aimed to perform a systematic review and meta-analysis of the complications following major and minor salivary gland biopsy. MATERIALS AND METHODS Observational studies assessing postoperative complications of minor salivary gland biopsy and indexed at Medline/PubMed, EMBASE, Cinahl, LILACS, or Scopus were selected. This review was registered under the protocol number: CRD42020211169. The level of significance considered was 0.05, and the R software (The R Foundation) was used for the meta-analysis. RESULTS Twenty-seven studies reporting 3208 patients were included in this review. The combined prevalence of postsurgical complications was 11% (95% CI, 8 to 13%, p = 0.01). The percentage of the combined prevalence of neurological complications was 3% (95% CI, 1-6%, p = 0.01). The surgical technique did not influence the frequency of overall and neurological complications. CONCLUSION Minor salivary gland biopsies are a safe and predictable procedure that should be performed on the lower lip. Postoperative complications are more common than previously reported, but permanent complaints are uncommon.
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Affiliation(s)
- Remberto M A Valdez
- Oral Medicine Unit, Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil
| | - Thayanara S Melo
- Oral Medicine Unit, Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil
| | - Alan R Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Angela Duarte
- Rheumatology Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Luiz A Gueiros
- Oral Medicine Unit, Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil
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Varoni EM, Villani G, Lombardi N, Pispero A, Lodi G, Sardella A, Uglietti D. Local complications associated with labial salivary gland biopsy for diagnosis of Sjögren's Syndrome: A retrospective cohort study. J Clin Exp Dent 2020; 12:e713-e718. [PMID: 32913566 PMCID: PMC7474941 DOI: 10.4317/jced.56562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/13/2020] [Indexed: 12/26/2022] Open
Abstract
Background To describe local or systemic complications related to the labial salivary glands biopsy (LSGB) used as diagnostic tool for the diagnosis of Sjögren’s Syndrome (SS).
Material and Methods Clinical databases from a cohort of patients, who underwent LSGB with provisional clinical diagnosis of Sjögren’s Syndrome, were retrospectively reviewed. Pain, assessed by registering the intake of analgesic drugs in the first week following the biopsy, and any further relevant clinical information regarding complications after biopsy were recorded.
Results 50 patients received LSGB. 10 of them (9 women and 1 man) showed histopathological findings compatible with SS. Ten patient (20%) receiving labial biopsy developed local complications: three of them (6%) reported a sensory defect at the surgical site that lasted at most few weeks; three patients (6%) reported pain sensation needing the assumption of analgesic drugs, while one patient (2%) described a transient local burning sensation, which resolved in few days. Three patients (6%) showed cutaneous haematoma in the surgical area and two patients (4%) showed mild mucosal inflammation at the biopsy site.
Conclusions LSGB is associated with to few and mild complications and it is a useful tool in the diagnosis of SS. The complications usually resolved in few weeks after the biopsy. Key words:Sjögren’s syndrome, labial salivary glands biopsy, adverse events, diagnosis.
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Affiliation(s)
- Elena M Varoni
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Gabriele Villani
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Niccolò Lombardi
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Alberto Pispero
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Lodi
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Andrea Sardella
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Daniela Uglietti
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy
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Spijkervet FKL, Haacke E, Kroese FGM, Bootsma H, Vissink A. Parotid Gland Biopsy, the Alternative Way to Diagnose Sjögren Syndrome. Rheum Dis Clin North Am 2016; 42:485-99. [PMID: 27431350 DOI: 10.1016/j.rdc.2016.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Salivary gland biopsy is a technique broadly applied for the diagnosis of Sjögren syndrome (SS), lymphoma in SS, and connective tissue disorders (sarcoidosis, amyloidosis). In SS characteristic histology findings are found, including lymphocytic infiltration surrounding the excretory ducts in combination with destruction of acinar tissue. In this article the main techniques are described for taking labial and parotid salivary gland biopsies with respect to their advantages, postoperative complications, and usefulness for diagnostic procedures, monitoring disease progression, and evaluation of treatment.
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Affiliation(s)
- Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Erlin Haacke
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Frans G M Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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A convenient and less invasive technique of labial minor salivary gland biopsy using a minimal incision with a needle tip. Clin Exp Otorhinolaryngol 2014; 7:222-5. [PMID: 25177440 PMCID: PMC4135160 DOI: 10.3342/ceo.2014.7.3.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 06/26/2013] [Accepted: 07/05/2013] [Indexed: 11/11/2022] Open
Abstract
Objectives This study was to show the technique and to compare the usefulness and complications of biopsy using a minimal incision with a needle tip of the labial minor salivary glands with those of conventional incisional lip biopsy in the diagnosis of Sjögren's syndrome. Methods We retrospectively reviewed the medical records of the patients who had the labial minor salivary gland biopsy for the diagnosis of Sjögren's syndrome between January 2005 and December 2008. One hundred forty-three patients were enrolled in this study. The yields of diagnostic salivary tissues and complications of the biopsy using a minimal incision with a needle tip and the conventional incisional lip biopsy were compared. Results Out of 143 patients, 56 patients underwent the conventional incisional lip biopsy and 87 patients received the biopsy using a minimal incision with a needle tip. In the biopsy using a minimal incision with a needle tip group, adequate salivary gland tissues were obtained in 85 patients out of 87 patients (97.7%). In the conventional incisional lip biopsy group, adequate specimens were acquired in 44 patients out of 56 patients (78.6%). There was no complication after the biopsy using a minimal incision with a needle tip, whereas there was one patient complained transient numbness of the lip after the conventional incisional lip biopsy. Conclusion The less invasive labial minor salivary gland biopsy using a minimal incision with a needle tip was easy to perform and safe and showed the better result than the conventional incisional lip biopsy in terms of the adequate specimen in the diagnosis of Sjögren's syndrome. So it might be a good alternative to the conventional incisional lip biopsy.
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Varela Centelles P, Sánchez-Sánchez M, Costa-Bouzas J, Seoane-Romero JM, Seoane J, Takkouche B. Neurological adverse events related to lip biopsy in patients suspicious for Sjögren's syndrome: a systematic review and prevalence meta-analysis. Rheumatology (Oxford) 2014; 53:1208-14. [PMID: 24599912 DOI: 10.1093/rheumatology/ket485] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the prevalence of neurological complications related to lip biopsy for SS diagnosis using conventional vs minimally invasive techniques. METHODS We performed a systematic review and prevalence meta-analysis using the search strategy [(salivary gland biopsy OR labial biopsy OR lip biopsy) AND (Sjögren)] in the MEDLINE, EMBASE and Web of Science Conference Proceedings Citation Index databases. Studies were selected if they included original data for minor salivary gland biopsy, sample size, exposure of interest (technique description), number of complications and number of affected patients. The prevalence of total and permanent neurological adverse effects was calculated. Both fixed-effects and random-effects pooled estimates were assessed. Heterogeneity was calculated using an adaptation of the DerSimonian and Laird Q test. RESULTS Sixteen articles were selected for the study. In the minimally invasive group (n = 3), the pooled prevalence of total adverse events is almost four times higher than that in the linear incision group (n = 12) (4.73% vs. 1.20%). In contrast, the pooled prevalence of the permanent or potentially permanent neurological adverse events is 8.5 times lower in the minimally invasive technique group than in the studies using linear incisions (0.17% vs. 1.45%). CONCLUSION With the limitations intrinsic to the potential biases in the studies included in this meta-analysis, we conclude that the minimally invasive lip biopsy technique for SS diagnosis induces fewer permanent neurological complications than conventional approaches with large linear incisions in the lower lip.
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Affiliation(s)
- Pablo Varela Centelles
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Department of Mathematics, Faculty of Informatics, University of A Coruña and Department of Preventive Medicine, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Mariña Sánchez-Sánchez
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Department of Mathematics, Faculty of Informatics, University of A Coruña and Department of Preventive Medicine, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Julián Costa-Bouzas
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Department of Mathematics, Faculty of Informatics, University of A Coruña and Department of Preventive Medicine, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Juan Manuel Seoane-Romero
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Department of Mathematics, Faculty of Informatics, University of A Coruña and Department of Preventive Medicine, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Juan Seoane
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Department of Mathematics, Faculty of Informatics, University of A Coruña and Department of Preventive Medicine, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Bahi Takkouche
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Department of Mathematics, Faculty of Informatics, University of A Coruña and Department of Preventive Medicine, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Delli K, Vissink A, Spijkervet FK. Salivary Gland Biopsy for Sjögren's Syndrome. Oral Maxillofac Surg Clin North Am 2014; 26:23-33. [DOI: 10.1016/j.coms.2013.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Varela-Centelles P, Seoane-Romero JM, Sánchez-Sánchez M, González-Mosquera A, Diz-Dios P, Seoane J. Minor salivary gland biopsy in Sjögren's syndrome: a review and introduction of a new tool to ease the procedure. Med Oral Patol Oral Cir Bucal 2014; 19:e20-3. [PMID: 23986014 PMCID: PMC3909427 DOI: 10.4317/medoral.19131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 04/17/2013] [Indexed: 11/16/2022] Open
Abstract
Objectives: To review the existing techniques for minor salivary gland biopsy (MSGB) in the lip and to suggest a new approach to ease the procedure and reduce post-operative complications.
Study Design: A comprehensive literature review and a descriptive study of a new surgical technique.
Results: Diverse incisions have been suggested for MSGB with different designs (ellipse, circular, linear), different directions (parallel, oblique, vertical) and a wide range of lengths (from 1 mm up to 3 cm), but no comparative studies supporting the advantages of a particular type of incision over the others could be retrieved. A variety of features of the existing techniques for MSGB are linked to undesired events and surgical complications which could be minimized by modifying certain aspects of these procedures. The technique described, together with the use of the S forceps, represents a significant improvement over the already described chalazion forceps because it allows for a better access and positioning of the lower lip, improves the ergonomic conditions of the assistant, and facilitates the identification of lip areas with more superficial gland lobules.
Conclusions: The suggested approach for lip MSGB includes a specifically designed instrument whose performance during lip biopsy may contribute to minimize post-operative complications.
Key words:Sjögren’s syndrome, diagnosis, minor salivary gland biopsy, surgical technique, lower lip.
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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:e851-5. [PMID: 23986021 PMCID: PMC3854076 DOI: 10.4317/medoral.19033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 05/03/2013] [Indexed: 11/08/2022] Open
Abstract
Objectives: To compare the reliability of two different labial salivary gland biopsy (LSGB) incision techniques (vertical versus horizontal incision techniques) and to report the related complications and discomfort.
Study Design: 163 patients who underwent LSGB were included in this study. Patients were randomly divided as vertical incision group (n=81) and horizontal incision group (n=82). Demographic and clinical information of each patient were recorded. A questionnaire was prepared and applied together with Visual Analog Scale (VAS) on the subjects verbally at the 7th day, postoperatively. Intraoperative, short- term and delayed complications were evaluated.
Results: The mean age of patients (117 female, 46 male) was 47.3 years (range 19-79 years). Vertical incision technique was associated with less pain (p<0.001), less swelling (p<0.05), less scar formation (p<0.05) and less difficulty in eating (p<0.05) when compared with horizontal incision technique. No statistically significant differences were observed between the 2 groups in terms of hematoma, parasthesia and speech difficulty (p>0.05). Additionally, two subjects in the horizontal incision group revealed permanent paresthesia during the follow-up period of two years.
Conclusions: This prospective study demonstrated that the subjects in the vertical incision group had less complication rates and discomfort after labial salivary gland procedure than those in the horizontal incision group.
Key words:Salivary gland, biopsy, incision.
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Affiliation(s)
- Alp Saruhanoğlu
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, 30490, Capa, Fatih, Istanbul, Turkey,
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Lida Santiago M, Seisdedos MR, García Salinas RN, Secco A, Marino Claverie L, Techera L, Takashima L, Aicardi P, Sandi Rosales MA, Knobel E, Magri SJ, Catalán Pellet AC. Frecuencia de complicaciones y rédito de la biopsia de glándula salival menor. ACTA ACUST UNITED AC 2012; 8:255-8. [DOI: 10.1016/j.reuma.2012.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 03/18/2012] [Accepted: 03/22/2012] [Indexed: 11/29/2022]
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Colella G, Cannavale R, Vicidomini A, Itro A. Salivary gland biopsy: a comprehensive review of techniques and related complications. Rheumatology (Oxford) 2010; 49:2117-21. [PMID: 20660500 DOI: 10.1093/rheumatology/keq225] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study proposes a revision of the literature on the current techniques employed in salivary gland biopsy. METHODS A systematic review of the literature between January 1990 and January 2010 was conducted using MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. The search terms were: 'biopsy AND parotid AND Sjögren'; 'biopsy AND sublingual salivary gland AND Sjögren'; 'biopsy AND minor salivary gland AND Sjögren'; 'biopsy AND labial salivary gland AND Sjögren' and 'biopsy AND salivary glands AND connective disorders'. RESULTS No study reporting submandibular salivary gland biopsy was found; 3 studies reported sublingual salivary gland biopsy; 1 study reported palate biopsy; 4 studies reported parotid gland biopsy and 21 studies reported minor salivary gland biopsy. CONCLUSION Biopsy of salivary glands must be performed as last investigation and only when the other items are not complete enough to satisfy the diagnosis. The knowledge of complications and sequelae may be useful in order to minimize the risk.
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Affiliation(s)
- Giuseppe Colella
- Department of Head and Neck Pathology, Second University of Naples, Naples, Italy.
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Krenn V, Jakobs M, Kriegsmann J, Krukemeyer MG, Rieger A. [Is bioptic assurance reasonable in patients with Sjögren's syndrome? From focus score to diagnosing vasculitides]. Z Rheumatol 2010; 69:11-8. [PMID: 19997922 DOI: 10.1007/s00393-009-0514-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sjögren's syndrome is an autoimmune disease which targets the salivary and lacrimal glands in particular, causing sicca syndrome. Extraglandular manifestations are often seen. Chronic sialadenitis of the parotid gland is the most common symptom to be assessed for differential diagnosis. Common HE and Giemsa slices are histopathologically examined and graduated for lymphocyte infiltration (focus): grade 0: absent, grade 1: slight, grade 2: moderate non-focal infiltration, grade 3: 1 focus (> or =50 lymphocytes) per 4 mm2, grade 4: >1 focus. Grade 3 infiltrates correspond to a focus score of 1, which is one of four disease-classifying criteria acknowledged for diagnosis. Bioptic examination is also performed to rule out different (non-) immunologic sialadenitises, such as the necrotizing or epithelioid-like form (in sarcoidosis), and the extranodal marginal-zone lymphoma. Extraglandular manifestations of Sjögren's syndrome can also be safely diagnosed by histopathological examination. Emphases lie on vasculitides and myositides. Bioptic work-up, therefore, is not only reasonable but also an essential tool for diagnostics in Sjögren's syndrome.
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Affiliation(s)
- V Krenn
- Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Max-Planck-Str. 18+20, 54296 Trier.
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Langerman AJ, Blair EA, Sweiss NJ, Taxy JB. Utility of Lip Biopsy in the Diagnosis and Treatment of Sjogren's Syndrome. Laryngoscope 2009; 117:1004-8. [PMID: 17417107 DOI: 10.1097/mlg.0b013e31804654f7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sjogren's syndrome (SS) is an autoimmune disease involving primarily the salivary and lacrimal glands ("sicca" symptoms) with extraglandular features including joint and nervous system involvement. In patients with a questionable diagnosis of SS but severe extraglandular symptoms, a lip biopsy is often performed to firmly establish the diagnosis of SS. This study was undertaken to identify areas of uncertainty regarding the accuracy of biopsy interpretation and the diagnostic benefits of the procedure. STUDY DESIGN : Retrospective review of clinical and pathologic data. METHODS Clinical data from 47 patients referred to the otolaryngology-head and neck surgery service for lip biopsy were reviewed. Archival pathologic specimens were scored using the currently accepted grading system. RESULTS The grading system was incorrectly applied during initial interpretation of 45% (n = 21) of specimens. This resulted in five (10%) pathologic misdiagnoses and 16 (34%) nondiagnoses. On re-interpreting the specimens with consistent application of the grading system, 62% (n = 29) of the biopsies were definitely positive, and 36% (n = 17) were negative. Neither positive serology nor the presence of sicca symptoms predicted a positive biopsy (likelihood ratio = 0.95 and 0.96, respectively). Lip biopsy guided treatment in at least 65% (n = 31) of patients but was ignored in the presence of other clinical findings in 17% (n = 8) of patients. CONCLUSIONS Consistent application of the grading system is essential in avoiding incorrect diagnosis and aiding clinical decisions. However, not all patients undergoing lip biopsy will derive diagnostic benefit from the procedure. In this series, clinical symptoms and serology did not predict positive lip biopsy.
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Affiliation(s)
- Alexander J Langerman
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois 60637, USA
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Baeteman C, Guyot L, Bouvenot J, Chossegros C, Cheynet F, Loudot C, Serratrice J, Attarian S. Faut-il encore effectuer des biopsies des glandes salivaires accessoires ? ACTA ACUST UNITED AC 2008; 109:143-7. [DOI: 10.1016/j.stomax.2007.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Accepted: 10/06/2007] [Indexed: 10/22/2022]
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