Bacha Dhouha, Touati Mourad, Meddeb Zeineb, Lahmar Ahlem, Hamzaoui Salwa, Ben Slama Sana
Pathology Department.
Internal Medicine Department; University Hospital Centre Mongi Slim, La Marsa Tunisia, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
Mediterr J Rheumatol. 2025 Jun 30;36(2):259-267. doi: 10.31138/mjr.080724.hba. eCollection 2025 Jun.
To examine the performance of the minor salivary gland biopsy (MSGB) to diagnose Sjögren's syndrome (SS) and to identify predictive factors for MSGB's positivity in Tunisian SS-suspected patients.
In a retrospective study, histopathological evaluation of MSGB from SS suspected- patients were examined. The classifications of the American-European Consensus Group (AECG, 2002) and the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR, 2016) have been applied. We classified a positive MSGB when a focus score ≥ 1 and/or Chisholm and Mason grading ≥ 3 were observed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MSGB were assessed, and the area under the ROC curve was performed to evaluate its diagnostic accuracy.
One hundred and two MSGBs were examined. They were positive in 48 patients (47%). For the positive diagnosis of SS, MSGB had 77,6% sensitivity, 93,2% specificity, 93,8% PPV and 75,9% NPV. With an air under the curve (AUC) of 0.854, MSGB was considered an excellent discriminating test in SS diagnosis. Keratoconjunctivitis sicca (p=0.04), elevated erythrocyte sedimentation rate (p=0.036), leukopenia (p=0.025), positive antibodies: anti-Ro/SSA (p=0.029), anti-Ro/SSA, anti-La/SSB (p=0.037), antinuclear (p=0.01), anti-extractable nuclear antigen (p=0.04), positive rheumatoid factor (p=0.032), positive elevated IgG levels (p=0.03) and abnormal unstimulated whole salivary flow rate (p=0.002) were predictive of a positive MSGB.
In cases of suspected SS, a predictive scoring system incorporating these clinical and biological factors will streamline MSGB indications and serve as a diagnostic tool for positive SS diagnosis in research studies.
研究小唾液腺活检（MSGB）在诊断干燥综合征（SS）中的表现，并确定突尼斯疑似SS患者MSGB阳性的预测因素。
在一项回顾性研究中，对疑似SS患者的MSGB进行组织病理学评估。采用了美国-欧洲共识小组（AECG，2002年）和美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR，2016年）的分类标准。当观察到焦点评分≥1和/或奇泽姆和梅森分级≥3时，我们将MSGB判定为阳性。评估了MSGB的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），并绘制ROC曲线下面积以评估其诊断准确性。
共检查了102例MSGB。其中48例患者（47%）呈阳性。对于SS的阳性诊断，MSGB的敏感性为77.6%，特异性为93.2%，PPV为93.8%，NPV为75.9%。MSGB的曲线下面积（AUC）为0.854，被认为是SS诊断中一项出色的鉴别试验。干燥性角结膜炎（p=0.04）、红细胞沉降率升高（p=0.036）、白细胞减少（p=0.025）、抗体阳性：抗Ro/SSA（p=0.029）、抗Ro/SSA、抗La/SSB（p=0.037）、抗核抗体（p=0.01）、抗可提取核抗原（p=0.04）、类风湿因子阳性（p=0.032）、IgG水平升高阳性（p=0.03）以及非刺激性全唾液流速异常（p=0.002）是MSGB阳性的预测因素。
在疑似SS的病例中，纳入这些临床和生物学因素的预测评分系统将简化MSGB的适应证，并可作为研究中SS阳性诊断的诊断工具。
