Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service de Médecine Interne, Lyon, France,
Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service de Médecine Interne, Lyon, France.
Eur Neurol. 2023;86(3):171-177. doi: 10.1159/000529920. Epub 2023 Mar 1.
The definite diagnosis of neurosarcoidosis is challenging since it requires a compatible histology of the nervous system. When neurosarcoidosis is suspected, other systemic manifestations are investigated to confirm the diagnosis. A minor salivary gland biopsy (MSGB) is often performed since it is minimally invasive. The objective of the present study was to assess its performance for the diagnosis of neurosarcoidosis.
A retrospective single-center study included patients who underwent a MSGB in a tertiary neurological university hospital (Lyon, France) between 2015 and 2018. Clinical presentations unlikely to be compatible with neurosarcoidosis were excluded. Positive cases of neurosarcoidosis were defined as definite, probable, and possible cases, according to the latest international neurosarcoidosis diagnostic criteria from the Neurosarcoidosis Consortium Consensus Group.
A total of 529 patients underwent a MSGB for clinical manifestations compatible with neurosarcoidosis. Among the 13 who fulfilled the criteria for neurosarcoidosis, only one had a positive MSGB. The sensitivity of MSGB was 7.7% (95% CI [0.2-36.0%]) and the specificity was 100.0% (95% CI [99.3-100%]).
Considering the low sensitivity of MSGB for the diagnosis of NS, MSGB should be performed in selected indications, including a suspicion of spinal cord sarcoidosis, or when there is a strong clinical, laboratory, and radiological suspicion of NS. MSGB should rather not be performed when the chest CT-scan does not show signs of pulmonary or lymph node sarcoidosis.
神经结节病的明确诊断具有挑战性，因为它需要神经系统的相容组织学。当怀疑神经结节病时，会调查其他全身表现以确认诊断。通常进行小唾液腺活检（MSGB），因为它具有微创性。本研究的目的是评估其对神经结节病诊断的性能。
回顾性单中心研究包括 2015 年至 2018 年在法国里昂的一所三级神经学大学医院进行 MSGB 的患者。排除临床表现不太可能与神经结节病相容的患者。根据神经结节病 Consortium Consensus Group 的最新国际神经结节病诊断标准，将神经结节病的阳性病例定义为明确、可能和可能的病例。
共有 529 名患者因与神经结节病相容的临床表现而接受 MSGB。在符合神经结节病标准的 13 名患者中，只有 1 名 MSGB 阳性。MSGB 的敏感性为 7.7%（95%CI[0.2-36.0%]），特异性为 100.0%（95%CI[99.3-100%]）。
考虑到 MSGB 对 NS 的诊断敏感性低，MSGB 应在特定适应症中进行，包括怀疑脊髓结节病，或当存在强烈的临床，实验室和影像学怀疑 NS 时。当胸部 CT 扫描未显示肺或淋巴结结节病的迹象时，不应进行 MSGB。
