saliva produced is determined by subtracting the original weight from the weight obtained after chewing. Normal production of saliva in 2 min is ³2.75 g [41].

26.4.4Iodine-Starch Reaction

A test tape (1 × 1 cm) containing iodine and starch is set in the mucosal area anterior to the labial frenulum for 30 s. The number of blue spots appearing on the strip corresponds to the number of ostia of the salivary gland on the lower lip. The average number of spots in patients with oral dryness is 4.5 ± 3.1 and in normal controls of 9.4 ± 2.5. SS patients have fewer spots than controls (2.1 ± 1.3) [38].

26.4.5Impression Cytology

Cellulose acetate paper is applied in the internal surface of the inferior lip and stained with hematoxylin and PAS. The normal lip epithelium is a stratified, nonkeratinized with absence of goblet cells. An abnormal cytology consists of poorly cohesive normal epithelial cells or isolated keratinized cells [37].

26.5Conclusion

Multiple different techniques exist to measure the production of tears or saliva either quantitatively or qualitatively. Some tests are most appropriate as screening assessments. Others are useful in the evaluation of gland function in subjects in whom suspicion of dysfunction has already been raised [46]. No single test of oral or ocular involvement is sufficiently sensitive and specific. The use of a combination of several tests is often recommended.

Currently, the European Study Group on Diagnostic criteria for SS recognizes as diagnostic ocular tests the use of the Schirmer test and the Rose Bengal staining test [12]. Non-stimulated whole saliva flow is the preferred oral test. Among all of the tests discussed in the present chapter, several have not been validated sufficiently for diagnostic purposes. However, we consider that they may be useful for screening patients with dry eyes/mouth or replace any of the validated tests in centers with enough experience with them.

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Chapter 27

Diagnostic Procedures (II): Parotid

Scintigraphy, Parotid Ultrasound, Magnetic

Resonance, Salivary Gland Biopsy

Gabriela Hernández-Molina, Eric Kimura-Hayama, María del Carmen Ávila-Casado, and Jorge Sánchez-Guerrero

Contents

Salivary gland involvement is a hallmark of Sjögren’s syndrome (SS). Besides the assessment of salivary gland function with objective tests such as sialometric methods, the analysis of gland specimens as well as some image methods are useful in the evaluation of these patients. For instance, the current American-European Consensus Group (AECG) criteria for SS [1] consider the performance of a labial salivary gland biopsy, salivary gland scintigraphy, and a sialography as tests to evaluate these patients. However, a standard algorithm for the evaluation of SS has not been established.

G. Hernández-Molina • J. Sánchez-Guerrero (*)

Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

E. Kimura-Hayama

Tomography Department, Instituto Nacional de Cardiología Ignacio, Chávez, Mexico City, Mexico

M.C. Ávila-Casado

Department of Pathology, Instituto Nacional de Cardiología Ignacio, Chávez, Mexico City, Mexico