Loukas Chatzis, Athanasios G. Tzioufas
Minor salivary gland biopsy occupies a distinctive position in the evaluation of Sjögren disease (SjD), offering diagnostic and prognostic insights that are rarely achievable in other systemic autoimmune conditions. It contributes essential diagnostic information, particularly for patients lacking anti-Ro/SSA antibodies or pediatric patients, and supports identification of key histopathologic features. Beyond its established diagnostic role, the biopsy carries prognostic information related to systemic involvement, B-cell activity, and lymphoma risk, supported by features such as ectopic germinal centers, lymphoepithelial lesions, and molecular monoclonality. Its clinical value extends to incident lymphoma detection and exclusion of diseases that mimic SjD. Emerging technologies - including standardized sampling approaches, digital pathology, and early applications of artificial intelligence - may further enhance diagnostic accuracy and prognostic utility. Although the procedure is generally safe, careful consideration is required to balance clinical benefit with patient burden. Overall, salivary gland biopsy remains a cornerstone for advancing SjD understanding and management.