Objective
We aim to investigate the association between salivary gland histopathological findings and the diagnosis, clinical features, autoantibodies, treatment outcomes, and disease course in patients with dryness.
Methods
This was a retrospective study on patients who underwent minor salivary gland biopsies in the process of diagnosing Sjögren's syndrome (SS) between January 2012 and September 2020. Data were collected through reviews of medical records and pathology slides.
Results
In total, 189 patients were enrolled in this study. The mean age was 52.8 ± 10.4 years, and the majority were female (97.9%). The diagnosis was primary SS in 112 (59.3%), secondary SS in 35 (18.5%), and sicca symptom due to other causes in 42 (22.2%). In histopathological findings, 138 (73.0%) were diagnosed with focal lymphocytic sialadenitis and 80 (49.7%) had 1 or more of the Focus score. Atrophy was present in 24.3%, fibrosis was present in 64.0%, and duct dilatation was present in 50.3%. Germinal center-like structures were present in 3.7%, and lymphoepithelial lesions were present in 8.5%. The only histopathological difference between patients diagnosed with SS and those without was the Focus score (1.9 vs. 0.3, p<0.001). The Focus score of primary SS was higher than those of secondary SS (p=0.023). The Focus score and atrophy were associated with inflammatory markers and autoantibodies such as antinuclear antibodies and anti-SS-A/Ro. The unstimulated whole salivary flow rate was lower in patients with atrophy (0.05 vs. 0.15 ml/min, p=0.011).
Conclusions
Among the histopathological findings of salivary glands, only the Focus score was related to the diagnosis of SS and was higher in patients with primary SS than in patients with secondary SS. In addition, other histopathological conditions may also be associated with autoantibodies, inflammatory levels, as well as glandular manifestations and function.