Discrepancies in Interpretation of the Minor Salivary Gland Biopsy in the Diagnosis of Sjögren Syndrome.

PURPOSE: Although the minor salivary gland biopsy (MSGB) is a major criterion for the diagnosis of Sjögren syndrome (SS), multiple studies have outlined difficulties in standardization. The purpose of this study was to answer the following question: in all patients referred for MSGB, did strict application of focus scoring criteria alter the sensitivity of and predictive value of the MSGB in the diagnosis of SS compared with the initial interpretation? MATERIALS AND METHODS: The authors designed a cross-sectional study of patients referred to the Massachusetts General Hospital Department of Oral and Maxillofacial Surgery (Boston, MA) over a 5-year period for MSGB. The primary predictor variable was the MSGB focus score. The primary outcome variable was the SS diagnosis. The newly established SS diagnosis status results were compared with the initial SS diagnoses. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. Other relevant variables of interest, such as size of glandular tissue harvested and associated signs and symptoms, also were documented. The primary predictor variable was the MSGB focus score and the primary outcome variable was the SS diagnosis (positive or negative). RESULTS: Seventy-three patients met the inclusion criteria. The mean age was 48.5 years (range, 19 to 71 yr) and 64 were women (87.6%). The authors' previous study using initial pathology reports yielded 80.0% sensitivity, 87.5% specificity, 57.1% PPV, and 95.5% NPV. The present review of the MSGB using strict focus scoring guidelines yielded 95.4% sensitivity, 76.4% specificity, 63.6% PPV, and 97.5% NPV. CONCLUSIONS: The MSGB is an important major criterion in establishing a diagnosis of SS. Application of strict focus scoring guidelines when reviewing the MSGB yielded a sensitivity far greater than initially reported in this group. Difficulties with interpretation are discussed. Future studies will focus on improvement of interpretation and immunohistochemical aids in diagnosis.

Minor Salivary Gland Biopsy-An Important Contributor to the Diagnosis of Sjögren Syndrome.

PURPOSE: Sjögren syndrome (SS), although commonly associated with xerostomia and xerophthalmia, can present with extraglandular manifestations that make definitive diagnosis difficult. The 2 leading diagnostic classification systems include a positive minor salivary gland biopsy (MSGB) result as a major inclusion criterion. The purpose of this study was to better define the role of the MSGB in establishing a diagnosis of SS in a cohort of referred patients. MATERIALS AND METHODS: This is a retrospective cohort study of patients referred to the Massachusetts General Hospital Department of Oral and Maxillofacial Surgery (Boston, MA) over a 5-year period to establish a diagnosis of SS. Inclusion criteria were complete information regarding presenting symptoms, reason for referral, and findings at MSGB. Incomplete records and referral for reasons other than presumptive SS resulted in exclusion. The MSGB and its role in definitive diagnosis based on accepted classification systems were evaluated for sensitivity, specificity, and positive and negative predictive values. Other variables of interest (demographics, pattern of referral, and symptomology) are described for the cohort. RESULTS: Eighty-seven patients met the inclusion criteria. The mean age was 48.3 years (range, 19 to 74 yr) and 75 were women (86.2%). Fifteen MSGB results (17.2%) were positive based on the focus score histologic criteria. In 12 of 15 cases, the positive MSGB result allowed for a definitive diagnosis (80%). In 3 cases, other criteria allowed diagnosis without the contribution of the MSGB (sensitivity of MSGB, 80.0%; specificity, 87.5%; positive predictive value, 57.1%; negative predictive value, 95.5%). CONCLUSION: The MSGB is an important contributor to a diagnosis of SS. When serology was negative, the MSGB often was the criterion that allowed the diagnosis to be established. It is the most frequently positive of the major criteria used by the 2 classification systems in current use.

Synchronous oral squamous cell carcinoma and a lymphoproliferative disorder in an adult: a challenge in diagnosis and management.

Synchronous primary malignancies present challenges in diagnosis, treatment sequencing and management. We present a rare case of a synchronous oral cavity and lymphoproliferative malignancy in a middle-age man. Our patient presented with a primary oral cavity squamous cell carcinoma and was subsequently found to have a secondary lymphoproliferative malignancy (chronic lymphocytic leukaemia/small lymphocytic lymphoma). The challenge of staging and sequencing of treatment is discussed. In addition, this case highlights the importance of multidisciplinary consultation, designing a personalised treatment plan that is coincident with the standard of care for each malignancy, and close follow-up.

Effects of a Research Requirement for Dental Students: A Retrospective Analysis of Students' Perspectives Across Ten Years.

For many years, Harvard School of Dental Medicine (HSDM) has had a research requirement for predoctoral students, but a recent curriculum assessment prompted a re-examination of that requirement and how it is implemented. The aim of this retrospective study was to assess the students' perspectives on research in a predoctoral dental program in which a research experience was mandatory for graduation. Data that had been collected in graduating student surveys from 2008 to 2017 were analyzed to gauge students' perceptions of the research program in the previous curriculum (New Pathways) and to seek insights to improve the next generation of this requirement in the Pathways curriculum. In the results, 74% of the students reported their research experience had a positive impact on their dental education. Half of the students (49%) indicated they would have pursued research even if it had not been a graduation requirement, while 37% were uncertain. A large majority (82%) said they would remain involved in research during their dental career. The majority of these HSDM students had contributed to scholarship with presentations and published results, planning of projects, or preparation of manuscripts. These results show that the research requirement has had a positive effect on students' perspectives on research as a part of their careers.