Increased Diagnostic Accuracy of the Labial Gland Biopsy in Primary Sjögren Syndrome When Multiple Histopathological Features Are Included.

Autor: van Ginkel MS; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Nakshbandi U; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Arends S; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Haacke EA; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Liefers SC; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Verstappen GM; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., van Nimwegen JF; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Brouwer E; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Stel AJ; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Spijkervet FKL; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Vissink A; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Bootsma H; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., van der Vegt B; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Kroese FGM; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Jazyk: angličtina
Zdroj: Arthritis & rheumatology (Hoboken, N.J.) [Arthritis Rheumatol] 2024 Mar; Vol. 76 (3), pp. 421-428. Date of Electronic Publication: 2024 Jan 09.
DOI: 10.1002/art.42723
Abstrakt: Objective: The aim of this study was to evaluate the diagnostic accuracy of the labial salivary gland biopsy based on multiple histopathological features in patients with suspected primary Sjögren syndrome (pSS).
Methods: Patients from a diagnostic sicca cohort with clinically suspected pSS who underwent a labial gland biopsy were included. Patients were categorized as having pSS or non-Sjögren syndrome sicca (non-SS sicca) based on vignettes scored by an expert panel. Labial gland biopsies were analyzed for the presence of four histopathological features: focus score (FS) ≥1, prelymphoepithelial and lymphoepithelial lesions, immunoglobulin G plasma cell shift, and germinal centers. Sensitivity and specificity of histologic features were calculated, and the optimal cutoff value for the number of histopathological features needed to diagnose pSS was determined with receiver operating curve analysis.
Results: A total of 38 patients were categorized as having pSS and 65 as having non-SS sicca. In labial gland biopsies of patients with pSS, the prevalence of FS ≥1 was 82%, followed by 68% for pre-lymphoepithelial and lymphoepithelial lesions, 63% for plasma cell shift, and 24% for germinal centers. Although FS ≥1 showed the highest sensitivity for patients with pSS (82%), specificity was higher for the other three features (98%-100%). The presence of two or more (of four) histopathological features had almost comparable sensitivity to FS alone, but specificity increased with 12% to 100%. For fulfillment of American College of Rheumatology/EULAR criteria, specificity increased from 84% to 95% when an abnormal biopsy was defined by the presence of two or more histopathological features instead of FS ≥1 only.
Conclusion: The diagnostic accuracy of the labial gland biopsy increases when other histopathological features besides FS are taken into account, by reducing the number of false-positive biopsies.
(© 2023 The Authors. Arthritis & Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)
Databáze: MEDLINE
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