Salivary gland biopsy in sarcoidosis

Previous studies have suggested that the simple technique of minor salivary gland biopsy might be a useful method of diagnosing sarcoidosis. We have therefore investigated the success of this technique in 25 consecutive patients who were attending a chest clinic and in whom a diagnosis of sarcoid had been made. The histological appearances of the minor salivary glands were correlated with the degree of gallium uptake by the parotid glands after intravenous injection of gallium citrate. We also compared the histological appearances of the sarcoid patients with 40 patients suffering from a variety of mixed connective tissue disorders (systemic lupus erythematosis, systemic sclerosis, primary Sjogrens syndrome, rheumatoid arthritis and polymyositis). Five out of twenty-five (20%) of the sarcoid patients had classical non-caseating granulomata in their minor salivary glands, four of whom also had hilar lymphadenopathy and one had bone marrow involvement. All the patients with sarcoid histology in their minor salivary glands also had Gallium uptake in parotid tissue. None of the patients with mixed connective tissue disorders had granulomata in their minor salivary gland tissue although a continuum of changes were found, ranging from normal appearances through small foci of lymphocytic infiltrate to extensive inflammation and destruction of glandular tissue with fibrosis. Whilst minor salivary gland biopsy may be a simple and rapid method of diagnosing sarcoidosis it is most likely to be positive in patients with hilar lymphadenopathy.