PDF: Diagnostic evaluation of serial sections of labial salivary gland biopsies in Sjögren’s syndrome


Sjögren’s syndrome is a chronic inflammatory disease. The detection of chronic inflammatory infiltrates containing >50 lymphocytes (lymphocytic focus) per 4 mm2 tissue in minor salivary gland biopsies is a diagnostic parameter of the disease.


The aim of the study was to examine if an increase in the tissue area of a single minor labial salivary gland biopsy through serial histological sections in patients affected by primary Sjögren’s syndrome could facilitate the detection of the diagnostic focus score (grades >1 or >2).


The disease mainly affects middle-aged women in a 10:1 ratio. No individual SS clinical or laboratory tests exist so far; therefore, the diagnosis is based on the combined evaluation of multiple clinical, serological, functional and morphological parameters, as originally proposed by a group of researchers supported by the European Community, and recently revised by the American-European Consensus Group.

The detection of chronic inflammatory infiltrates containing >50 lymphocytes (lymphocytic focus) per 4 mm2 tissue in minor salivary gland biopsies (MSGB) is the diagnostic morphological parameter of SS.


Based on the presence and number of lymphocytic foci, Daniels and Greenspan formulated a focus score (FS) ranging from 0 to >2, whose diagnostic specificity and sensitivity to SS is detectable in grades >1 and >2.

Although the inflammatory involvement includes all the exocrine glands, in SS the distribution of lymphocytic infiltrates in single glands is uneven (unifocal, plurifocal), easily leading to an over- or underestimation of the diagnostic FS in a single 4 mm2 histological section. 

Since the method of biopsy sampling for minor salivary glands is well-established as for size (4 mm2) and number of fragments (one), in recent years the possibility was suggested to increase the tissue area, maximizing the number of lymphocytic foci, and therefore the diagnostic value of the biopsy through serial sections at different standard levels of the same biopsy sample.



This study was inspired by the results obtained in recent studies present in the literature, which denied the possibility of reproducing the same focus score in serial sections obtained at different depths in biopsies of minor salivary glands of patients affected by Sjögren’s syndrome.






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