Contributions to lip biopsy procedures for the diagnosis of Sjögren syndrome

Abstract

Salivary gland biopsy is one of the criteria employed for the diagnosis of Sjögren syndrome, mainly relying on the presence of focal sialadenitis (focus score ≥1) in minor salivary glands. Despite this clear advantage and the morbidity associated to the procedure, such as occasional sever neurological complications, there is no standard technique for undertaking lip biopsies. Currently, there are different surgical approaches for harvesting glandular tissue from the inner side of the lip, characterised by the size, orientation, and type of the incision as well as by the biopsy site. An updated, comprehensive, literature review has been undertaken together with an assessment of the procedures described for performing biopsies of minor salivary glands, which resulted on the need for improving both instruments and biopsy methods in order to diminish patient morbidity. Second, a pilot study aimed at examining the presence of nerve fibres in minor salivary glands tissue samples obtained by two procedures (punch vs. linear incisional technique). Within the limitations the study, our results strongly discourage punch techniques for minor salivary gland lip biopsies and provide information on the superiority of linear incisional biopsies in terms of neural damage. Finally, a new technique for minor salivary gland biopsy, with a potential for minimising the reported adverse effects of the procedure while easing the process and improving tissue stability, will be investigated