Minimally-Invasive Technique For The Biopsy Of Minor Salivary Glands: Searching For Systemic Infiltrative Diseases In Patients Presenting With Sicca Symptoms

Background Sicca syndrome is common for several systemic diseases that may infiltrate the exocrine glands. The most frequent disease is Sjogren9s syndrome (SS), but also sarcoidosis, amyloidosis or IgG4-related disease may infiltrate salivary glands. Objectives To analyze the safety and usefulness of minimally-invasive lip biopsy technique in patients presenting with immunonegative sicca syndrome suspecting a systemic disease. Methods A prospective analysis of 96 patients with a sicca syndrome, positive ocular tests and/or parotid scintigraphy and negative anti-Ro/La in whom a minimally-invasive biopsy of minor salivary glands (with no stitches) was carried out at a single center. Chisholm Mason score -CMS- was evaluated, together with investigation of granuloma, amyloid, IgG4-cells, lipids. Results All biopsies but one disclosed salivary gland tissue. Histopathological diagnosis consisted of sialoadenitis (n=67), normal glandular tissue (n=22), lipoid infiltration (n=4) amyloidosis (n=1), and salivary oncocytic cystadenoma (n=1). Patients with sialoadenitis were more frequently female (87% vs 68%, p=0.046) and had a higher mean age (61.49 vs 55.27 years, p=0.047) in comparison with patients with normal biopsy. CMS classification score classified lymphoplasmocytic infiltration as absent (grade 0, n=11), mild (grade 1, n=39), moderate (grade 2, n=8), and severe (grade 3, n=4, and grade 4, n=5). No correlation was found between the degree of infiltration and ocular tests, parotid scintigraphy or with ANA, RF, monoclonal gammopathy, hypocomplementemia. Twenty-seven (40%) patients with sialoadenitis were classified as atrophic sialadenitis (periductal fibrosis and/or acinar atrophy); these patients had a higher mean age in comparison with patients with a non-atrophic sialoadenitis (69.22 vs 56.28 years, p Conclusions More than half patients with sicca syndrome immunonegative (Ro/La) showed a non-specific chronic sialoadenitis, that might reflect a “mild” pSS that has no place in the current classification criteria of this autoimmune disease. Lack of lymphocytic infiltration and atrophic histopathological data closely correlated with an older age. Minimally-invasive biopsy of minor salivary glands is a simple, safe, and reliable tool for the diagnosis of infiltrative systemic diseases of exocrine glands. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5132