title: Clinical characteristics and biopsy accuracy in suspected cases of Sjögren's syndrome referred to labial salivary gland biopsy.
abstract: BACKGROUND
  Labial salivary gland biopsy (LSGB) is the most important diagnostic tool for the diagnosis of Sjögren's syndrome (SS), but its diagnostic value is rarely studied. This study assessed the sensibility and specificity of LSGB, and the clinical profiles of patients who were referred for biopsy.
  
  
  METHODS
  Retrospective analysis of the histopathological reports from LSGB and medical report data from patients who underwent LSGB between 2008 and 2011 was conducted.
  
  
  RESULTS
  About 290 biopsies were performed and 74 were excluded due to insufficient clinical data. Of the 216 patients, 0.46% was carrier of hepatitis C virus, 30.1% had primary SS (pSS), and 8.8% had secondary SS (sSS). Of the samples, 94.3% presented dryness symptoms, 51.6% experienced dryness only, 42.7% had systemic manifestations, and 66.9% presented low unstimulated salivary flow and/or Schirmer's test. LSGB was necessary in 67.6% to confirm the presence of SS based on the American-European Consensus Group 2002 criteria (AECG). Based on specialist's opinion, sensibility level was 86.57%, and specificity was 97.43%. Positive predictive value (PPV) was 95%, and negative predictive value (NPV) was 92.6%. Determined accuracy was 93.3%. Concordance (kappa coefficient) of LSGB and specialist's opinion was 0.851, and LSGB with AECG criteria was 0.806. Of the 98 patients referred with fibromyalgia and dryness, 36.7% had SS and LSBG focus score of ≥ 1. Patients with SS were older, and showed more severe lachrymal and salivary dysfunctions, greater frequency of fibromyalgia, anti-nuclear antibodies (ANA), anti-SSA-Ro, and anti-SSB-La.
  
  
  CONCLUSIONS
  Labial salivary gland biopsy has high sensibility, specificity, positive and negative predictive values for diagnosis of pSS. In the clinical practice, it is useful, especially for those patients with glandular dysfunctions and negative antibodies.
authors.affiliation: Medical Clinic Department, Center of Health Science, Federal University of Espírito Santo, Vitória, Brazil. raquel.altoe@terra.com.br.|Universitary Hospital Cassiano Antônio de Moraes, Av. Marechal Campos, 1460, CEP 29040-090, Vitória, Brazil. raquel.altoe@terra.com.br.
authors.forename: Raquel A
authors.initials: RA
authors.lastname: Giovelli
authors.affiliation: Pathology Department, Center of Health Science, Federal University of Espírito Santo, Vitória, Brazil. maria.c.santos@ufes.br.|Universitary Hospital Cassiano Antônio de Moraes, Av. Marechal Campos, 1460, CEP 29040-090, Vitória, Brazil. maria.c.santos@ufes.br.
authors.forename: Maria C S
authors.initials: MC
authors.lastname: Santos
authors.affiliation: Universitary Hospital Cassiano Antônio de Moraes, Av. Marechal Campos, 1460, CEP 29040-090, Vitória, Brazil. ericavserrano@gmail.com.
authors.forename: Érica V
authors.initials: ÉV
authors.lastname: Serrano
authors.affiliation: Medical Clinic Department, Center of Health Science, Federal University of Espírito Santo, Vitória, Brazil. val.valim@gmail.com.|Universitary Hospital Cassiano Antônio de Moraes, Av. Marechal Campos, 1460, CEP 29040-090, Vitória, Brazil. val.valim@gmail.com.
authors.forename: Valéria
authors.initials: V
authors.lastname: Valim
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D005260:Female; D006801:Humans; D007742:Labial Frenum; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012469:Salivary Glands / Q000473:pathology* / Q000503:physiopathology; D012472:Salivation; D012859:Sjogren's Syndrome / Q000097:blood / Q000473:pathology* / Q000503:physiopathology
chemical_list: D000974:Antibodies, Antinuclear; D015415:Biomarkers; C035356:SS-A antibodies; C035357:SS-B antibodies