Minor Salivary Gland Biopsy in Suspected Sjögren Disease: Diagnostic Value of Fluorescein-assisted Preoperative Gland Evaluation
Sowmya V. Kothandan, Vidhi Anklesaria, Moumi Maity, Tirupathi R. Mocherla, Dilip K. Mishra, Swati SinghPurpose:
To predict the diagnostic value of the fluorescein-assisted labial salivary gland test (FAST) in diagnosing Sjögren disease (SjD) and its correlation with biopsy positivity.
Methods:
Consecutive patients presenting with aqueous-deficient dry eye, that is, dry eye symptoms plus Schirmer less than 10 mm in 1 eye and positive ocular staining, were investigated for SjD using serology and labial minor salivary gland (MSG) biopsy. Using the FAST technique, the number of actively secreting MSGs and the flow rate were calculated in μL/min. Receiver operating characteristic curves, sensitivity, and specificity were calculated.
Results:
Of 43 patients with aqueous-deficient dry eye, 23 (56.6%) had a focus score greater than 1, and 2 were seropositive for SS-A or SS-B. Twenty-seven (62.8%) reported dry mouth, of which only 14 were biopsy-positive. The median gland number and mean MSG flow rate were 11 (interquartile range, 11) 0.81 ± 0.8 μL/min in biopsy-positive cases, and 18.5 (8) 1.4 ± 0.9 μL/min in biopsy-negative cases, respectively. Receiver operating characteristic analysis demonstrated that both flow and gland number were associated with biopsy positivity. Flow showed moderate diagnostic performance (area under curve (AUC) = 0.68), with an optimal cutoff of <1.21 μL/min yielding 73.9% sensitivity and 73.7% specificity. Gland number demonstrated better discrimination (AUC = 0.73), with a cutoff of <14.5 providing 69.6% sensitivity and 78.9% specificity. There was a moderately positive correlation between the glandular area observed on histology and gland number and flow.
Conclusions:
FAST can assist in identifying the labial biopsy site containing confluent, actively secreting glands, especially near the lip commissures, and in increasing the glandular area captured on histology in suspected SjD patients.