J Rheum Dis.  2014 Dec;21(6):303-310. 10.4078/jrd.2014.21.6.303.

A Meta-analysis of the Diagnostic Value of Minor Salivary Gland Biopsy for Primary Sjogren's Syndrome

• Lee YH
• Song GG

• KMID: 2222934
• DOI: http://doi.org/10.4078/jrd.2014.21.6.303

Abstract

OBJECTIVE
The purpose of this study is to evaluate the diagnostic performance of minor salivary gland biopsy (MSGB) for patients with primary Sjogren's syndrome (pSS).
METHODS
We have conducted a search from Medline, Embase, and Cochrane Library databases, and performed a meta-analysis on the diagnostic accuracy of MSGB in pSS patients.
RESULTS
A total of eight studies, including 583 pSS and 627 non-pSS patients, were available for the meta-analysis. The pooled sensitivity and specificity of MSGB were 75.7% (95% confidence interval [CI], 72.0~79.1) and 90.7% (88.1~92.9), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 9.475 (4.051~22.16), 0.266 (0.208~0.340), and 38.92 (19.12~72.21), respectively. The area under the curve was 0.901 and the Q*; index was 0.902, indicating a high diagnostic accuracy. Some between-study heterogeneity was found in the meta-analyses; however, there was no evidence of a threshold effect (Spearman correlation coefficient= 0.419; p=0.301). Meta-regression showed that the study quality, sample size, study design, and diagnostic criteria were not sources of heterogeneity, and subgroup meta-analyses did not change the overall diagnostic accuracy.
CONCLUSION
Our meta-analysis of published studies demonstrates that MSGB has a high diagnostic accuracy and may play an important role in the diagnosis of pSS.

Keyword

Primary Sjogren's syndrome; Minor salivary gland biopsy; Diagnostic accuracy; Meta-analysis

MeSH Terms

Biopsy*
Diagnosis
Humans
Odds Ratio
Population Characteristics
Salivary Glands, Minor*
Sample Size
Sensitivity and Specificity
Sjogren's Syndrome*

Figure

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  Figure 1. Flow diagram of study selection.

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  Figure 2. Sensitivity (A) and specificity (B) estimates for minor salivary gland biopsy for the diagnosis of primary Sjogren's syndrome. Circles and lines represent point estimates and 95% confidence intervals, respectively. Circled areas represent relative study sizes.

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  Figure 3. Positive (A) and negative (B) likelihood ratios, and diagnostic odds ratio (C) estimates for minor salivary gland biopsy for the diagnosis of primary Sjogren's syndrome. Circles and lines represent point estimates and 95% confidence intervals, respectively. Circled areas represent the relative study size.

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  Figure 4. Summary receiver-operating characteristic curves for minor salivary gland biopsy for the diagnosis of primary Sjogren's syndrome. Solid circles represent individual studies included in this meta-analysis. The curve shown is a regression line that summarizes the overall diagnostic accuracy. SE (AUC): standard error of the area under the curve, Q*: an index defined by the point on the SROC curve where the sensitivity and specificity are equal, SE(Q*): Q* index standard error.

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