title: Multilevel examination of minor salivary gland biopsy for Sjogren's syndrome significantly improves diagnostic performance of AECG classification criteria.
abstract: The recently observed low reproducibility of focus score (FS) assessment at different section depths in a series of single minor salivary gland biopsies highlighted the need for a standardized protocol of extensive histopathological examination of such biopsies in Sjogren's syndrome. For this purpose, a cumulative focus score (cFS) was evaluated on three slides cut at 200-mum intervals from each of a series of 120 salivary biopsies. The cFS was substituted for the baseline FS in the American-European Consensus Group (AECG) criteria set for Sjogren's syndrome classification, and then test specificity and sensitivity were assessed against clinical patient re-evaluation. Test performances of the AECG classification with the original FS and the score obtained after multilevel examination were statistically compared using receiver operating characteristic (ROC) curve analysis. The diagnostic performance of AECG classification significantly improved when the cFS was entered in the AECG classification; the improvement was mostly due to increased specificity in biopsies with a baseline FS >or= 1 but <2. The assessment of a cFS obtained at three different section levels on minor salivary gland biopsies can be useful especially in biopsies with baseline FSs between 1 and 2.
authors.affiliation: Department of Pathology, IRCCS Policlinico S Matteo, Pavia, Italy. p.morbini@smatteo.pv.it
authors.forename: Patrizia
authors.initials: P
authors.lastname: Morbini
authors.forename: Antonio
authors.initials: A
authors.lastname: Manzo
authors.forename: Roberto
authors.initials: R
authors.lastname: Caporali
authors.forename: Oscar
authors.initials: O
authors.lastname: Epis
authors.forename: Chiara
authors.initials: C
authors.lastname: Villa
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.forename: Enrico
authors.initials: E
authors.lastname: Solcia
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012470:Salivary Glands, Minor / Q000473:pathology*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000145:classification / Q000175:diagnosis / Q000473:pathology*
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