Sjogren Sendromu Şüphesi ile Minör Tükürük Bezi Biyopsisi Yapılan Hastaların Klinik Özellikleri ve Sonuçları

Öz

Amaç: Sjogren sendromu şüphesi ile minör tükürük bezi biyopsisi yapılan hastaların sonuçlarının değerlendirilerek biyopsinin Sjögren sendromu (SS) tanısındaki yerini ve değerini saptamak. Gereç ve Yöntemler: Çalışma, SS tanısı için biyopsi yapılan 127 hastanın sonuçlarının geriye dönük değerlendirilmesi ile planlandı. Minör tükürük bezi biyopsisi uygulanan hastaların klinik ve laboratuvar özellikleri dosyalarından kaydedildi. SS teşhisi, 2016 ACR/EULAR sınıflandırma kriterlerine göre veya uzman görüşüne göre konuldu. Bulgular: 113 hasta çalışmaya dahil edilme kriterlerini karşıladı. Sjogren sendromu tanısı konulan 72 hasta vardı. 72 hastanın 56 tanesine 2016 ACR/EULAR sınıflandırma kriterlerine göre tanı konulurken, 16 tanesine uzman görüşüne göre tanı konuldu. Minör tükürük bezi biyopsi sonucu pozitif 57 (55 SS, 2SS değil), negatif 56 (17SS, 39SS değil) kişi vardı. Minör tükürük bezi biyopsisinin SS tanısı için duyarlılığı %76,4, özgüllüğü ise %95,1 idi. Sonuç: Hastalarımızın tamamında antikor testi sonucu vardı ancak tükürük akış hızı ve Schirmer gibi sınıflandırma kriterlerinde yer alan objektif testi olan hasta sayısı düşüktü. Minör tükürük bezi biyopsisi invaziv bir teknik olarak görülse de deneyimli profesyoneller tarafından yapıldığı sürece güvenli bir teknik gibi görünmektedir. SS şüphesi olan ve diğer objektif testlerin uygulanmadığı hastalarda kesin karara varılmasında yardımcı olacaktır

Anahtar Kelimeler

• sjogren sendromu,
• tanı,
• minör tükürük bezi biyopsisi

Clinical characteristics and results of patients who underwent minor salivary gland biopsy with the suspicion of Sjogren syndrome

Öz

Objective: To evaluate the value and accuracy of biopsy in diagnosing Sjogren syndrome (SS) by evaluating the results of patients who underwent mınor salivary gland biopsy (MSGB) with the suspicion of SS. Material and Methods: The study was planned with a retrospective assessment of 127 patients with a biopsy performed for SS diagnosis. The clinical and laboratory characteristics of the patients who underwent MSGB were recorded from their files. SS diagnosis was placed using the rating system according to 2016 ACR/EULAR classification criteria or based on expert opinion. Results: 113 patients met the ınclusion criteria. 72 patients diagnosed with SS. 56 were diagnosed according to the 2016 ACR/EULAR classification criteria and 16 were diagnosed according to expert opinion. There were 57 patients with positive MSGB outcomes (55 SS, 2 not SS). There were 56 patients with MSGB negative outcomes (17 SS, 39 not SS). The sensitivity of MSGB for SS diagnosis was 76.4%, and the specificity was 95.1%. Conclusion: All of our patients had antibody test results, but the number of objective tests included in the classification criteria such as salivary flow rate and Schirmer was low. Although MSGB is considered an invasive technique, it appears to be safe technique as long as it is performed by experienced professionals. It will assist in the final decision for patients with SS suspicion and who cannot undergo other objective tests.

Anahtar Kelimeler

• sjogren syndrome
• diagnosis
• minor salivary biopsy

Kaynakça

1. Ramos-Casals M., Tzioufas A. G. (2005). Font J. Primary Sjögren’s syndrome: new clinical and therapeutic concepts. Annals of the rheumatic diseases, 64(3), 347-354. DOI: 10.1136/ard.2004.025676
2. Pertovaara M., Korpela M., Uusitalo H., Pukander J., Miettinen A., Helin H., Pasternack A. (1999). Clinical follow up study of 87 patients with sicca symptoms (dryness of eyes or mouth, or both). Annals of the rheumatic diseases, 58(7), 423-427. DOI: 10.1136/ard.58.7.423
3. Asmussen K., Andersen V., Bendıxen G., Schıødt M., Oxholm P. (1996). A new model for classification of disease manifestations in primary Sjögren's syndrome: evaluation in a retrospective long‐term study. Journal of internal medicine, 239(6), 475-482. DOI: 10.1046/j.1365-2796.1996.418817000.x
4. Chisholm, D. M., Mason, D. (1968). Labial salivary gland biopsy in Sjögren's disease. Journal of clinical pathology, 21(5), 656-660. DOI: 10.1136/jcp.21.5.656
5. Shiboski, CH, Shiboski, SC, Seror, R, Criswell, LA, Labetoulle, M, Lietman, TM, Rasmussen, A, Scofield, H, Vitali, C, Bowman, SJ, Mariette, X, Heidenreich, AM, Lanfranchi, H, Vollenweider, C, Schiødt, M, Devauchelle, V, Gottenberg, JE, Saraux, A, Pincemin, M, Dörner, T, Tzoufias, A, Baldini, C, Bombardieri, S, De Vita, S, Kitagawa, K, Sumida, T, Umehara, H, Bootsma, H, Kruize, AA, Radstake, TR, Vissink, A, Jonsson, R, RamosCasals, M, Theander, E, Challacombe, S, Fisher, B, Kirkham, B, Larkin, G, Ng, F, Rauz, S, Akpek, E, Atkinson, J, Baer, AN, Carsons, S, Carteron, N, Daniels, T, Fox, B, Greenspan, J, Illei, G, Nelson, D & International Sjögren's Syndrome Criteria Working Group 2017, '2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts', Arthritis and Rheumatology, vol. 69, no. 1, pp. 35- 45. https://doi.org/10.1002/art.39859
6. Shiboski, S. C., Shiboski, C. H., Criswell, L., Baer, A., Challacombe, S., Lanfranchi, H., Schiødt, M., Umehara, H., Vivino, F., Zhao, Y., Dong, Y., Greenspan, D., Heidenreich, A. M., Helin, P., Kirkham, B., Kitagawa, K., Larkin, G., Li, M., Lietman, T., Lindegaard, J., … Sjögren's International Collaborative Clinical Alliance (SICCA) Research Groups (2012). American College of Rheumatology classification criteria for Sjögren's syndrome: a data-driven, expert consensus approach in the Sjögren's International Collaborative Clinical Alliance cohort. Arthritis care & research, 64(4), 475–487. https://doi.org/10.1002/acr.21591
7. Giovelli RA., Santos MC., Serrano ÉV., Valim V. (2015). Clinical characteristics and biopsy accuracy in suspected cases of Sjögren’s syndrome referred to labial salivary gland biopsy. BMC musculoskeletal disorders, 16, 1-7. DOI: 10.1186/s12891-015-0482-9
8. Edelstein R., Kilipiris GE., Machalekova K., Mouzalini E., Slobodianuk A., Javorka V. (2021). Accuracy of minor salivary gland biopsy in the diagnosis of Sjögren syndrome. Bratislavske Lekarske Listy, 122(7), 454-460. DOI: 10.4149/BLL_2021_075

9. Guellec, D., Cornec, D., Jousse-Joulin, S., Marhadour, T., Marcorelles, P., Pers, J. O., Saraux, A., & Devauchelle-Pensec, V. (2013). Diagnostic value of labial minor salivary gland biopsy for Sjögren's syndrome: a systematic review. Autoimmunity reviews, 12(3), 416–420. https://doi.org/10.1016/j.autrev.2012.08.001