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Sjögren Syndrome Salivary gland biopsies show focal aggregates of lymphocytes, plasma cells, and macrophages; there may be larger foci with the appearance of germinal centers. This appearance is characteristic of chronic lymphocytic sialadenitis.

This minor procedure calls for removal of four or more salivary gland lobules through a small incision in the inner lip. A biopsy is considered to be positive if histopathologic analysis shows a focus score of greater than or equal to 1 per 4 mm2 of tissue (a focus is defined as a cluster of 50 or more lymphocytes).

An important method for establishing the diagnosis is to take a biopsy of the salivary glands in order to determine whether inflammation is present, and if so, its type and severity. The minor salivary glands just under the inner surface of the lip are the most accessible of these glands.

The biopsy site should be selected from the inner side of the lower lip, rich in minor salivary glands, avoiding the midline area due to its lesser content of glandular component (Fig.

The skin or mucous membrane over the gland is cleaned with rubbing alcohol. A local pain-killing medicine (anesthetic) may be injected, and a needle is inserted into the gland. A piece of tissue or cells are removed and placed on slides. The samples are sent to the lab to be examined.

Biopsies should be performed by individuals who are familiar with the lip biopsy procedures, this includes Oral Medicine specialists, and certain Oral Surgeons and Otolaryngologists (ENTs).

The diagnosis of Sjögren's syndrome (SS) in these patients is necessarily supported by a positive test for anti-Ro/SSA antibodies and/or a labial salivary gland biopsy showing focal lymphocytic sialadenitis with a focus score ≥1 (ie, "positive" lip biopsy).

Minor salivary gland biopsy is an important technique that has been used for >50 years to assess for focal lymphocytic sialadenitis in patients suspected to have SS. Originally, this was performed by excising an elliptical segment of oral mucosa containing labial salivary gland tissue.