title: A retrospective, multicenter study evaluating the prognostic value of minor salivary gland histology in a large cohort of patients with primary Sjögren's syndrome.
abstract: OBJECTIVE
  The objective of this report is to investigate the prognostic value of minor salivary glands (MSG) assessment, routinely performed with hematoxilin-eosin (H&E) staining, for the diagnosis of primary Sjögren's syndrome (pSS).
  
  
  METHODS
  We retrospectively evaluated clinical, serological and histological features of 794 pSS patients. H&E-stained sections were assessed using the Chisholm and Mason grading system and/or the focus score (FS).
  
  
  RESULTS
  FS allowed the identification of a number of differences in the disease spectrum, and its prognostic role was further confirmed by quantifying the association between FS value and clinical/serological variables with binary logistic regression. Moreover, hypocomplementemia and FS resulted the only variables associated with lymphoma at univariate analysis, and FS appeared to be associated with lymphoma independently on complement fraction concentrations. Conversely, when patients were divided according to the Chisholm and Mason grading system, we failed to observe any significant difference between subgroups.
  
  
  CONCLUSIONS
  In addition to its diagnostic role, our data seem to support that the routine assessment of MSG-FS with H&E staining is useful to predict at the time of diagnosis the adverse outcomes, such as lymphoma and extraglandular manifestations, that complicate the pSS course. On this basis, it should be recommended that an MSG biopsy be performed even in those patients displaying clinical and serological criteria, allowing the diagnosis of pSS independent of histological status.
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila, L'Aquila, Italy francescocarubbi@libero.it.
authors.forename: F
authors.initials: F
authors.lastname: Carubbi
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Alunno
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Cipriani
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Bartoloni
authors.affiliation: Rheumatology Unit, University of Pisa, Pisa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Baldini
authors.affiliation: Rheumatology Clinic, DSMB, University of Udine, Udine, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Quartuccio
authors.affiliation: Rheumatology Unit, La Sapienza University of Rome, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Priori
authors.affiliation: Rheumatology Unit, La Sapienza University of Rome, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Valesini
authors.affiliation: Rheumatology Clinic, DSMB, University of Udine, Udine, Italy.
authors.forename: S
authors.initials: S
authors.lastname: De Vita
authors.affiliation: Rheumatology Unit, University of Pisa, Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bombardieri
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Gerli
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Giacomelli
mesh_terms: D003430:Cross-Sectional Studies; D004801:Eosine Yellowish-(YS); D005260:Female; D006416:Hematoxylin; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012469:Salivary Glands / Q000473:pathology*; D012859:Sjogren's Syndrome / Q000473:pathology*
chemical_list: D004801:Eosine Yellowish-(YS); D006416:Hematoxylin
keywords: Chisholm and Mason grading system; Primary Sjögren’s syndrome; focus score; lymphoma; minor salivary gland biopsy