The minor salivary gland biopsy as a diagnostic tool for Sjogren syndrome

Objectives/Hypothesis: In suspected cases of Sjogren syndome (SS), patients are often referred for a labial minor salivary gland biopsy. However, studies have shown this test to be unreliable. Pathologic misinterpretation and immunosuppressive medications may affect the results of the biopsy. As a result, it is best to perform this procedure only when necessary. The purpose of the current study was to review clinical signs and symptoms of patients who underwent a lip biopsy to determine which patients benefited most from this procedure. Study Design: Retrospective review. Methods: A retrospective chart review of patients referred to otolaryngology for a lip biopsy for the diagnosis of SS. Results: Joint pain, salivary gland swelling, and abnormal serology (anti‐Sjogren syndrome A/anti‐Sjogren syndrome B) were more prevalent in the positive lip biopsy group (grade = 3 or 4). Out of the 12 patients who had both sicca symptoms and positive serology, nine (75%) had a grade = 4. Presence of sicca symptoms and positive serology were predictive of a positive biopsy ( P = .017). Excluding those patients who were on immunosuppression for more than 6 weeks prior to the biopsy, the correlation became stronger ( P = .011). Conclusions: In this study, clinical presentation of sicca symptoms and positive serology reliably predicted the results of a lip biopsy. The results of this study suggest that patients with clear criterion for SS may not require a lip biopsy, especially those patients on immunosuppression. When physicians suspect SS, a thorough clinical and laboratory examination is necessary to determine if a patient will benefit from a minor salivary gland biopsy. Laryngoscope, 2009