Related Experiment Video
Updated: Jun 26, 2026
Ultrasonographic Evaluation of Salivary Glands for Sjogren's Syndrome: Diagnostic and Monitoring Insights
Published on: October 13, 2023
Standardization of minor salivary gland biopsy interpretation in Sjögren's disease using the 2017 EULAR
Clarice Garcia Valadares Xavier1, Débora Cerqueira Calderaro2, Stanley de Almeida Araújo3
1Post Graduate Program in Sciences Applied to Adult Health Care, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Objectives:
To assess the inter- and intra-rater reliability of minor salivary gland biopsy (MSGB) interpretation for the evaluation of Sjögren's disease (SjD), in accordance with the 2017 EULAR recommendations.
Methods:
The reproducibility of MSGB findings in patients with suspected SjD was analysed by two pathologists. For intra-rater reliability, expert examiner A (ExA) evaluated 196 slides twice, with a 2-month interval, following a standardized blinded protocol. For inter-rater reliability, ExA's initial assessment was compared with that of the routine service pathologists (ExR) and with expert examiner B (ExB), who independently evaluated a random subset of 115 slides. Agreement for qualitative variables was assessed using Cohen's kappa coefficient (κ), and the intraclass correlation coefficient (ICC) was calculated for quantitative measures.
Results:
Inter- and intra-rater analyses demonstrated substantial to almost perfect agreement (κ ≥ 0.6) for glandular area, dichotomized focus score (FS; ≥1 or <1) and the diagnosis of focal lymphocytic sialadenitis (FLS). In contrast, agreement for structural damage assessment was only moderate to fair (κ ≤ 0.4) across both analyses. The ICC for FS indicated good reliability (≥0.61) between ExR and ExA, and almost perfect reliability (ICC ≥0.76) between ExA and ExB, as well as within ExA's intra-rater comparison.
Conclusion:
Inter- and intra-rater reliability for diagnosing FLS and determining FS is good, whereas reliability for grading structural damage remains limited. This discrepancy may reflect less consistent training and criteria for assessing tissue damage compared with inflammatory features. Improving MSGB reproducibility will require stronger standardization of histopathological procedures and enhanced pathologist training.
