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Article

Minor Salivary Gland Biopsy in the Differential Diagnosis of Sicca Syndrome: A Monocentric Cohort Analysis

by
Elisa Fiorentini
1,*,
Pamela Bernardini
1,
Dorilda Zeka
1,
Marco Capassoni
1,
Luca Novelli
2,
Annarita Palomba
2,
Lorenzo Tofani
3,
Laura Cometi
1,* and
Serena Guiducci
1
1
Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, 50134 Florence, Italy
2
Department of Services, Laboratory of Pathological Histology and Molecular Diagnostics, University of Florence, AOU Careggi, 50134 Florence, Italy
3
Department of Statistics, Computer Science, Applications, University of Florence, 50134 Florence, Italy
*
Authors to whom correspondence should be addressed.
Int. J. Mol. Sci. 2025, 26(13), 6463; https://doi.org/10.3390/ijms26136463
Submission received: 30 May 2025 / Revised: 30 June 2025 / Accepted: 1 July 2025 / Published: 4 July 2025
(This article belongs to the Special Issue Sjogren's Disease: Multidimensional Perspectives on Pathogenesis, Clinical Manifestations, and Therapeutic Advancements)
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Abstract

Sicca syndrome is a common condition that draws the attention of rheumatologists, and is frequently related to Sjögren’s disease (SjD). This study analyzed 164 patients with sicca syndrome (clinically suspected for SjD) who underwent minor salivary gland biopsy (mSGB). Patients completed the Xerostomia Inventory (XI) and Standard Patient Evaluation of Eye Dryness (SPEED) questionnaires to assess Patient-Reported Outcome Measures (PROMs), and biopsies were graded using the Chisholm and Mason system. Patients were classified as seropositive (SSA, SSB, Ro52, Ro60 positive) or seronegative, and also divided into three groups by age. Positive biopsies (60.37%) were more common in older patients (61–80) and associated with confirmed SjD, more severe xerostomia, and stronger lymphocytic infiltrates. Among these, 37.37% were seropositive, showing higher disease activity, hypergammaglobulinemia, and elevated IgG. Seronegative patients had a heavier symptom burden, confirmed by the PROMs, and more fibrosis and fatty replacement in biopsies. Age-stratified analysis showed younger patients (18–40) were more affected by ocular dryness, while older patients had worse xerostomia and more severe histological and ultrasound changes. Younger individuals had higher IgG/IgA, more anemia, and reduced C3. Hydroxychloroquine was used more in younger and seropositive groups; older patients used more topical therapies. These results highlight mSGB’s diagnostic value, especially in seronegative cases, and stress the importance of combining clinical, histological, imaging, and patient-reported outcomes for optimal care.
Keywords: Sjögren’s disease; minor salivary gland biopsy; patient-reported outcomes Sjögren’s disease; minor salivary gland biopsy; patient-reported outcomes

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MDPI and ACS Style

Fiorentini, E.; Bernardini, P.; Zeka, D.; Capassoni, M.; Novelli, L.; Palomba, A.; Tofani, L.; Cometi, L.; Guiducci, S. Minor Salivary Gland Biopsy in the Differential Diagnosis of Sicca Syndrome: A Monocentric Cohort Analysis. Int. J. Mol. Sci. 2025, 26, 6463. https://doi.org/10.3390/ijms26136463

AMA Style

Fiorentini E, Bernardini P, Zeka D, Capassoni M, Novelli L, Palomba A, Tofani L, Cometi L, Guiducci S. Minor Salivary Gland Biopsy in the Differential Diagnosis of Sicca Syndrome: A Monocentric Cohort Analysis. International Journal of Molecular Sciences. 2025; 26(13):6463. https://doi.org/10.3390/ijms26136463

Chicago/Turabian Style

Fiorentini, Elisa, Pamela Bernardini, Dorilda Zeka, Marco Capassoni, Luca Novelli, Annarita Palomba, Lorenzo Tofani, Laura Cometi, and Serena Guiducci. 2025. "Minor Salivary Gland Biopsy in the Differential Diagnosis of Sicca Syndrome: A Monocentric Cohort Analysis" International Journal of Molecular Sciences 26, no. 13: 6463. https://doi.org/10.3390/ijms26136463

APA Style

Fiorentini, E., Bernardini, P., Zeka, D., Capassoni, M., Novelli, L., Palomba, A., Tofani, L., Cometi, L., & Guiducci, S. (2025). Minor Salivary Gland Biopsy in the Differential Diagnosis of Sicca Syndrome: A Monocentric Cohort Analysis. International Journal of Molecular Sciences, 26(13), 6463. https://doi.org/10.3390/ijms26136463

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