Labial salivary gland biopsies in Sjögren's syndrome: still the gold standard?

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Sep;106(3):392-402. doi: 10.1016/j.tripleo.2008.04.018. Epub 2008 Jul 7.


Objectives: The accuracy and diagnostic benefits of the labial salivary gland (LSG) biopsy for Sjögren's syndrome (SS) have received mixed reviews. This study was conducted to assess (1) the inter-rater agreement among 5 pathologists, and (2) the relationship between biopsy findings and clinical disease parameters.

Study design: Three oral pathologists (OP) and two surgical pathologists (SP) provided independent diagnoses, focus scores, and plasma cell characterizations for 37 LSG biopsies. Inter-rater reliability was assessed using percentage of overall agreement and intraclass correlation coefficients. Relationships between diagnoses and clinical parameters were assessed by nonparametric correlations.

Results: Overall agreement among the pathologists was poor, although the intra-specialty agreement was good. The ratings of OP were most highly correlated with serological measures, while those of SP were correlated with salivary flow rate and disease damage.

Conclusion: Since the LSG biopsy can be the determining factor in SS diagnoses, these demonstrated inconsistencies merit further consideration.

MeSH terms

  • Adult
  • Aged
  • Biopsy
  • Female
  • Humans
  • Lip
  • Lymphocytes
  • Middle Aged
  • Observer Variation
  • Plasma Cells
  • Predictive Value of Tests
  • Reference Standards
  • Saliva / metabolism
  • Salivary Glands, Minor / pathology*
  • Secretory Rate
  • Sjogren's Syndrome / blood*
  • Sjogren's Syndrome / diagnosis*