Caracterização histológica de biópsia de glândula salivar menor como fator diagnóstico e prognóstico de paciente com Síndrome de Sjögren

Abstract

Sjögren's Syndrome (SS) is a chronic systemic autoimmune disease, where a Minor Salivary Gland Biopsy (BGSM) plays a key role in the disease classification criteria. This study aimed to perform a histological characterization of minor salivary glands (GSM) with positive histology for SS using the recommendations of Fisher et al. (2017) in addition to comparing conventional and digital histopathological analyses. Over a period of 10 years, 123 patients with reports suspected of having SS were kept at the Department of Pathology and Forensic Medicine at the Federal University of Amazonas (DPML / UFAM). Of these, 50 were selected for presenting a routine report with a positive biopsy for SS. After applying the eligibility criteria, 32 cases were included to be evaluated microscopically applying the 2017 criteria. The intra-observer agreement of the analyzes both by the conventional method and by the digital method were transferred by means of Intraclass Reliability Coefficient (ICC) using continuous variables number of foci, glandular parenchyma area and focus score (FS) ≥1 in the different techniques. Additionally, exclusively qualitative histological characterization was performed. There was diagnostic agreement between the positive histopathological reports of the file and the histopathological evaluation in this research in 75% (n = 24) of the sample. In the conventional analysis, the mean number of foci was 8.5 foci (± 4), with an ICC of 0.835, a glandular area with an average of 19.5 mm² (± 10.7), with an ICC of 0.966, and the mean SF of 2.04 (± 1.05). In the digital method, the variables measured were the glandular area, which had an average of 12.4 mm² (± 6.8), with an ICC of 0.976 and the SF, which had an average of 3.2 (± 1, 5). When comparing the FS chosen in each method, there was an ICC of 0.769, evidencing different FS results in each evaluation method, but the diagnosis did not vary. Among the characteristics, it has the presence of fibrosis (95.83%), adipose infiltration (45.83%), ductal dilatation (95.83%), acinar atrophy (100%) and lymphoepithelial lesion (LESA) (33.33 %) and germinal center (CG) (4.16%) important for the prognosis of the lesion. It was possible to conclude in this study that the BGSM in patients with suspected SS is extremely important due to its diagnostic and prognostic conclusions, however stages of its assessment may be related to subjectivity to a greater or lesser degree, especially in relation to the count of foci lymphocytes. It is suggested that an LESA and CG have a low prevalence in GSM of patients with SS, and may be inconsistently reported. The digital analysis presents the FS frequently overestimated in relation to the conventional method, which could have repercussions in prognosis, but not the diagnosis.