Minimally Invasive Minor Salivary Gland Biopsy for the Diagnosis of Amyloidosis in a Rheumatology Clinic

Abstract

Background. Systemic amyloidosis is a potentially fatal condition, unless diagnosed and treated before development of irreversible organ damage. Demonstration of amyloid deposits within tissue biopsies is only definitive diagnostic method, which makes appropriate selection of biopsy site essential. Herein, we evaluated efficacy of minimally invasive minor salivary gland biopsy (MSGB) for the diagnosis of amyloidosis. Methods. We analyzed 37 biopsies taken from 35 patients. Suggestive findings for amyloidosis were significant proteinuria, renal impairment, refractory diarrhea, neuropathy, and restrictive cardiomyopathy. Minor salivary gland was the initial biopsy site in all subjects. When MSGB was negative but there was a high suspicion for amyloidosis, a kidney, duodenum, or rectal biopsy was performed for further investigation. Results. Mean age of patients was 45.4 and 21 were female. In 11 patients amyloidosis was diagnosed with MSGB. In overall 18 patients were diagnosed with amyloidosis. Sixteen of them were identified as being of AA type and two were AL type amyloidosis. The sensitivity of minimally invasive MSGB is 61.1% for diagnosing amyloidosis in this study. Conclusion. MSGB is a safe and simple method for the diagnosis of amyloidosis which can be performed in an outpatient setting. We suggest extensive use of this minimally invasive method.

Familial Mediterranean fever, from pathogenesis to treatment: a contemporary review

“…A kidney biopsy is recommended whenever the urinary protein excretion exceeds 0.5 g/24 h to exclude AA amyloidosis [140]. More convenient sites for the tissue biopsies are abdominal fat and minor salivary glands [141]. The other option for patients with suspected amyloidosis is the use of a serum amyloid P (SAP) scan but it is only available at certain centers [142].…”

Adverse post‐operative events of salivary gland biopsies: A systematic review and meta‐analysis

“…Notably, there was a strong predominance of female patients (83.76%) (Table S2). The average follow-up period after the biopsy presented large variation and included 1 month, 12,14,23,24 1 year 11,13,25,26 or even 2 years. [27][28][29] Four studies compared the lip biopsy with parotid gland biopsy.…”

“…Neurological complications were the most common postsurgical complication in 20 studies, followed by pain, [12][13][14][15][23][24][25]27,33 swelling, 12,13,22,23,27,33 and hematoma. 14,15,22,23,27 Three studies 9,28,37 reported no complications.…”

“…[8][9][10] Despite being a minimal, safe, simple, and well-accepted surgical procedure, LMSGB has been associated with postoperative complications. [11][12][13] Lip paresthesia, pain, bleeding, postoperative local discomfort, swelling, and bruising are the most common complications, with a wide range of reported frequency. 14,15 There is currently an increase in the indication for performing LMSGB on patients with or suspected of having SS, and other diseases.…”

Transthyretin familial amyloid polyneuropathy

“…Для биопсии пригодны также почка, кожа, желудок, слизистая оболочка прямой кишки, икроножный нерв, удерживатель сгибателей и околосухожильный жир, полученный после оперативного вмешательства по поводу кистевого туннельного синдрома, слюнная железа. Малоинвазивная биопсия слюнной железыбезопасный и простой метод выявления амилоидоза, который может быть выполнен в амбулаторных условиях без подготовки к процедуре, его чувствительность составляет 61% [28,29]. Чувствительность эндоскопической биопсии слизистой оболочки желудочно-кишечного тракта составляет 85%, в то время как биопсия икроножного нерва является менее чувствительной.…”