Abstract
BackgroundEvaluating lymphocytic infiltration of minor salivary gland biopsy in primary Sjögren’s syndrome is challenging. We developed and evaluated a digital method for quantifying B and T lymphocytes in whole minor salivary gland biopsy slides.MethodsMinor salivary gland biopsies were immunostained with anti-CD20/anti-CD3 antibodies using red/brown chromogens. Slides were digitised and spliced into mosaics of smaller JPEG format images in which red and brown pixels were counted. ImageJ Cell counter was used for validation. Agreement between the digital and manual methods was evaluated using Bland-Altman plots and the interclass correlation coefficient. External validation relied on the Chisholm-Mason, Tarpley, and focus-score methods.ResultsOf 62 minor salivary gland biopsy slides, 61.3 % had a Chisholm-Mason grade ≥ III or a focus score ≥1. The number of pixels correlated well with manual cell counts (r = 0.95 for red pixels vs. B cell count and r = 0.91 for brown pixels vs. T cell count). Interclass correlation coefficients between digital and manual counts were excellent (0.92 for B/T cells). B-cell proportion showed a significant positive correlation with the focus score (Spearman’s coefficient 0.463, p < 0.0001). Median B-cell proportion was lower in minor salivary gland biopsies with Chisholm grades I–II (2.5 % (0.2–13.9)) than III–IV (30.0 % (15.5–45.2)) and increased with Tarpley’s class (1, 2.2 % (0.2–6.6); 2, 27.2 % (13.0–38.9); and 3–4, 48.5 % (29.4–56.4); p < 0.001 for all comparisons). Minor salivary gland biopsy B-cell proportion was also significantly correlated with several markers of clinical and biological activity of the disease, especially with markers of systemic B-cell hyperactivation.ConclusionThe digital procedure proved accurate compared to the reference standard, producing reliable results for whole tissue sections.Trial registrationClinicalTrials.gov [NCT00740948]. Registered 22 August 2008.
Highlights
Evaluating lymphocytic infiltration of minor salivary gland biopsy in primary Sjögren’s syndrome is challenging
The current reference standard for diagnosing Primary Sjögren’s syndrome (pSS) is a specific pattern of focal lymphocytic sialadenitis in labial minor salivary gland biopsies (MSGBs), defined as the presence of one or more dense aggregates of ≥50 lymphocytes adjacent to apparently normal tissue [1, 6,7,8,9]
Discrepancies were noted for dense infiltrates containing over 200 lymphocytes per JPEG format image
Summary
Evaluating lymphocytic infiltration of minor salivary gland biopsy in primary Sjögren’s syndrome is challenging. Primary Sjögren’s syndrome (pSS) is a common chronic autoimmune disease characterised by lachrymal and salivary gland dysfunction due in part to lymphocytic infiltration and tissue destruction [1,2,3,4,5]. The current reference standard for diagnosing pSS is a specific pattern of focal lymphocytic sialadenitis in labial minor salivary gland biopsies (MSGBs), defined as the presence of one or more dense aggregates of ≥50 lymphocytes adjacent to apparently normal tissue [1, 6,7,8,9]. T and B cells predominate by far among the inflammatory cells, and the proportion of B cells increases with lesion severity and histopathological scores [17]. The most advanced lesions contain tertiary ectopic lymphoid structures, which may have germinal centres [18,19,20]
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