Wicheta Sarah, Van der Groen Troy, Faquin William C, August Meredith
Student, Harvard School of Dental Medicine, Boston, MA.
Professor, Department of Pathology, Massachusetts General Hospital, Massachusetts General Hospital, Boston, MA.
J Oral Maxillofac Surg. 2017 Dec;75(12):2573-2578. doi: 10.1016/j.joms.2017.05.021. Epub 2017 May 30.
Sjögren syndrome (SS), although commonly associated with xerostomia and xerophthalmia, can present with extraglandular manifestations that make definitive diagnosis difficult. The 2 leading diagnostic classification systems include a positive minor salivary gland biopsy (MSGB) result as a major inclusion criterion. The purpose of this study was to better define the role of the MSGB in establishing a diagnosis of SS in a cohort of referred patients.
This is a retrospective cohort study of patients referred to the Massachusetts General Hospital Department of Oral and Maxillofacial Surgery (Boston, MA) over a 5-year period to establish a diagnosis of SS. Inclusion criteria were complete information regarding presenting symptoms, reason for referral, and findings at MSGB. Incomplete records and referral for reasons other than presumptive SS resulted in exclusion. The MSGB and its role in definitive diagnosis based on accepted classification systems were evaluated for sensitivity, specificity, and positive and negative predictive values. Other variables of interest (demographics, pattern of referral, and symptomology) are described for the cohort.
Eighty-seven patients met the inclusion criteria. The mean age was 48.3 years (range, 19 to 74 yr) and 75 were women (86.2%). Fifteen MSGB results (17.2%) were positive based on the focus score histologic criteria. In 12 of 15 cases, the positive MSGB result allowed for a definitive diagnosis (80%). In 3 cases, other criteria allowed diagnosis without the contribution of the MSGB (sensitivity of MSGB, 80.0%; specificity, 87.5%; positive predictive value, 57.1%; negative predictive value, 95.5%).
The MSGB is an important contributor to a diagnosis of SS. When serology was negative, the MSGB often was the criterion that allowed the diagnosis to be established. It is the most frequently positive of the major criteria used by the 2 classification systems in current use.
干燥综合征（SS）虽然通常与口干症和干眼症相关，但也可能出现腺体外表现，这使得明确诊断变得困难。两种主要的诊断分类系统都将小唾液腺活检（MSGB）结果阳性作为主要纳入标准。本研究的目的是更好地确定MSGB在一组转诊患者中建立SS诊断的作用。
这是一项对转诊至麻省总医院口腔颌面外科（马萨诸塞州波士顿）以明确SS诊断的患者进行的回顾性队列研究。纳入标准为关于现患症状、转诊原因和MSGB检查结果的完整信息。记录不完整以及因疑似SS以外的原因转诊的患者被排除。根据公认的分类系统评估MSGB及其在明确诊断中的作用，包括敏感性、特异性、阳性预测值和阴性预测值。描述了该队列的其他相关变量（人口统计学、转诊模式和症状学）。
87例患者符合纳入标准。平均年龄为48.3岁（范围19至74岁），75例为女性（86.2%）。根据焦点评分组织学标准，15例（17.2%）MSGB结果为阳性。在15例中的12例中，MSGB结果阳性使得能够明确诊断（80%）。在3例中，其他标准使得无需MSGB的辅助即可诊断（MSGB的敏感性为80.0%；特异性为87.5%；阳性预测值为57.1%；阴性预测值为95.5%）。
MSGB是SS诊断的重要依据。当血清学检查结果为阴性时，MSGB常常是能够确立诊断的标准。它是目前使用的两种分类系统所采用的主要标准中最常呈阳性的标准。
