Labial salivary gland biopsies in Sjögren's syndrome: still the gold standard?

Carol M Stewart, Indraneel Bhattacharyya, Kathleen Berg, Donald M Cohen, Christine Orlando, Peter Drew, Nadim M Islam, Junu Ojha, Westley Reeves
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 2008, 106 (3): 392-402

OBJECTIVES: 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.

STUDY DESIGN: 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.

CONCLUSION: Since the LSG biopsy can be the determining factor in SS diagnoses, these demonstrated inconsistencies merit further consideration.

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