title: Labial salivary gland biopsies in Sjögren's syndrome: still the gold standard?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Since the LSG biopsy can be the determining factor in SS diagnoses, these demonstrated inconsistencies merit further consideration.
authors.affiliation: Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL 32610, USA. cstewart@dental.ufl.edu
authors.forename: Carol M
authors.initials: CM
authors.lastname: Stewart
authors.forename: Indraneel
authors.initials: I
authors.lastname: Bhattacharyya
authors.forename: Kathleen
authors.initials: K
authors.lastname: Berg
authors.forename: Donald M
authors.initials: DM
authors.lastname: Cohen
authors.forename: Christine
authors.initials: C
authors.lastname: Orlando
authors.forename: Peter
authors.initials: P
authors.lastname: Drew
authors.forename: Nadim M
authors.initials: NM
authors.lastname: Islam
authors.forename: Junu
authors.initials: J
authors.lastname: Ojha
authors.forename: Westley
authors.initials: W
authors.lastname: Reeves
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D008046:Lip; D008214:Lymphocytes; D008875:Middle Aged; D015588:Observer Variation; D010950:Plasma Cells; D011237:Predictive Value of Tests; D012015:Reference Standards; D012463:Saliva / Q000378:metabolism; D012470:Salivary Glands, Minor / Q000473:pathology*; D012636:Secretory Rate; D012859:Sjogren's Syndrome / Q000097:blood* / Q000175:diagnosis*