Session Title: Sjögren's Syndrome - Clinical
Session Type: Abstract Submissions (ACR)
Histopathological analysis of minor salivary glands is a part of the latest classification criteria for SS proposed by the American-European Consensus Group (AECG), and the ACR.1, 2 Recently it has been proposed that the presence of germinal center like structures in diagnostic minor salivary gland biopsies may be a highly predictive marker for NHL development in primary SS.3 Our aim was to prospectively evaluate adverse events of minor salivary gland biopsy performed by rheumatologists in patients suspect of having Sjögren’s syndrome.
At our rheumatology department we run a weekly diagnostic outpatient clinic where we see patients presenting with symptoms suggestive of Sjögren’s syndrome referred to us by their rheumatologists. We evaluate them using the AECG criteria. In consenting patients who cannot be classified on the basis of history, clinical tests, and serological tests we perform the minor salivary gland biopsy.
Under aseptic conditions an assistant exposes mucosa of the lower lip. We clean it with 0.2% chlorhexidine digluconate solution, and infiltrate the lateral third of the lip with approx. 0.5–1 cm3 of 2% lidocaine near one of the many orifices of the minor salivary gland excretory ducts identified by observation of nascent droplets of saliva. The rheumatologist makes an approx. 5 mm linear incision of the mucosa, removes all the exposed glands using a forceps, and places a single suture to close the wound using 4-0 absorbable braided polyglycolic acid. Removed glands are transported to pathology laboratory in 10% formalin.
Before the biopsy we informed each patient orally and in writing about possible adverse events and appropriate responses. Ten days to two weeks following the biopsy, a nurse phoned each patient to inquire about the pain (0-10 scale, VAS) during biopsy, and in the week following it; the survival of sutures, and whether the patient’s GP or dentist had to remove them; and any other adverse events experienced by the patient.
From 02/01/2007 to 12/15/2010 350 patients were referred for biopsy (89.7% females, average age 56.9±12.5 years). Incision length was measured and was on average 5.0±0.8 mm. The average volume of the obtained tissue sample was 26.5±72.8 mm3.
322 patients responded to the follow up call by the nurse. During the biopsy 89.8%, 5.3%, and 1.5% reported pain on VAS of 0, 1–3, and 4–5, respectively, while 3.4% provided no answer. In the week following the biopsy 78.9%, 12.4%, 2.8%, 1.9%, 0.9% scored their pain on VAS 0, 1–3, 4, 5, and 6–8, respectively, while 3.1% provided no answer. 80.1% of patients report no adverse events, the rest complained about paresthesia, wound suppuration, hematoma, irritating mucosal scar, and lower lip swelling in 5.6%, 5%, 3.4%, 3.4%, and 2.5%, respectively. All the adverse events were transient and have resolved within the first three days after biopsy in 95.5% of patients.
The average suture survival was 3.7±2.1 days. In 15.5% of patients sutures were removed by their GP or dentist after on average 4.8±2.3 days.
Minor salivary gland biopsy is a safe outpatient procedure in the hands of rheumatologists.
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