Minor Salivary Gland Biopsy in Sjögren Disease: From Diagnostic Criterion to Clinical Decision Tool

Minor salivary gland biopsy (MSGB) remains an important tool in the evaluation of patients with suspected Sjögren disease (SjD), particularly when the clinical presentation and serologic findings are inconclusive.Although traditionally used to identify focal lymphocytic sialadenitis and determine a focus score, the potential clinical value of MSGB extends beyond a binary positive or negative result.Histopathologic findings may provide additional information about glandular inflammation, lymphoid organization, epithelial injury, fibrosis, and disease phenotype.MSGB may be particularly useful in anti-Sjögren syndrome-related antigen A/Ro (anti-SSA/Ro)-negative disease and may have a role in childhood-onset disease and the assessment of features associated with systemic disease and lymphoma risk.The procedure can generally be performed in an outpatient setting, although sensory complications should be discussed before biopsy.Salivary gland ultrasonography (SGUS) provides a complementary, noninvasive assessment of glandular structure and may help identify patients who require further tissue evaluation.This narrative review discusses the practical indications for MSGB, biopsy technique and safety, histopathologic interpretation, its role in anti-SSA/Ro-negative and childhood-onset disease, prognostic implications, relationship to SGUS, and emerging applications in tissue-based phenotyping and precision medicine.