title: Safety and usefulness of minor salivary gland biopsy: retrospective analysis of 502 procedures performed at a single center.
abstract: OBJECTIVE
  To analyze the safety of our biopsy technique and the effectiveness of minor salivary gland biopsy (MSGB) for the diagnosis of Sjögren's syndrome (SS) and amyloidosis.
  
  
  METHODS
  We conducted a retrospective analysis of 452 patients with suspected SS and 50 with suspected amyloidosis and negative periumbilical fat aspiration analysis who underwent MSGB at a single center. Diagnostic evaluation for SS included Schirmer's test, unstimulated whole salivary flow, detection of antinuclear antibodies and anti-SSA/SSB, erythrocyte sedimentation rate, C-reactive protein, IgM rheumatoid factor, and serology for hepatitis C virus. For all biopsy samples, a cumulative focus score on multilevel sections was calculated. SS was diagnosed according to American-European Consensus Group (AECG) criteria. Histologic evaluation for amyloidosis was performed using Congo red staining and polarized-light microscopy. Adverse events were recorded on a questionnaire immediately after the procedure and 7 days, 14 days, and 6 months thereafter.
  
  
  RESULTS
  Sixty-four patients (12.7%) reported transient adverse events: 40 paresthesias lasting <7 days, 17 paresthesias lasting <14 days, 27 cases of local swelling, and 8 external hematoma. One patient has had local paresthesia for 2 years. A total of 498 (99.2%) samples provided adequate material for histologic analysis. Of 452 patients evaluated for SS, 378 were finally evaluated. Ninety-three patients (24.5%) had a cumulative focus score > or =1, and 87 (94.5%) of 93 satisfied the AECG criteria. Classification of SS was possible for 124 (32.8%) of 378 patients. In 51 (41%) of 124, MSGB was essential to reach the number of criteria needed for classification. Of 50 patients evaluated for amyloidosis, 10 (20%) had positive Congo red staining.
  
  
  CONCLUSIONS
  MSGB is a simple, safe, and reliable tool for the diagnosis of SS and amyloidosis, and therefore is suitable for more extensive application.
authors.affiliation: Department of Rheumatology, University of Pavia, IRCCS San Matteo Foundation, Pavia, Italy. caporali@smatteo.pv.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Caporali
authors.forename: Eleonora
authors.initials: E
authors.lastname: Bonacci
authors.forename: Oscar
authors.initials: O
authors.lastname: Epis
authors.forename: Francesca
authors.initials: F
authors.lastname: Bobbio-Pallavicini
authors.forename: Patrizia
authors.initials: P
authors.lastname: Morbini
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000473:pathology*; D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012466:Salivary Gland Diseases / Q000473:pathology*; D012469:Salivary Glands / Q000473:pathology*; D012859:Sjogren's Syndrome / Q000473:pathology*