The Clinical Utility of Labial Gland Biopsy in Patients With Suspected Neuro-Sjögren.

BACKGROUND: Neuro-Sjögren, the neurological subtype of Sjögren's Disease (SjD), is difficult to diagnose due to its heterogeneity and diverse manifestations. While the diagnostic role of labial gland biopsy (LGB) in SjD is established, its significance in Neuro-Sjögren remains unclear. OBJECTIVE: To assess the diagnostic utility of LGB in patients with suspected Neuro-Sjögren. METHODS: We conducted a retrospective cross-sectional study at Xuanwu Hospital, Capital Medical University (2019-2023). Of 456 patients with suspected SjD, 135 were classified as suspected Neuro-Sjögren and 277 as suspected non-Neuro-Sjögren. According to our center's diagnostic pathway, with reference to the 2016 ACR/EULAR criteria, patients were categorized into LGB-required (n = 91) and non-LGB-required (n = 44) groups. Logistic regression identified factors associated with LGB requirement. LGB-required patients were further stratified into LGB-positive (n = 74) and LGB-negative (n = 17) for clinical and laboratory comparison. RESULTS: Suspected Neuro-Sjögren patients demonstrated higher LGB requirement (67.4% vs. 56.3%, p = 0.031) and positivity (81.3% vs. 51.3%, p < 0.001) compared with suspected non-Neuro-Sjögren patients. Independent factors associated with biopsy requirement included younger age at onset and early-onset neurological symptoms, whereas anti-SSB positivity and ANA titers ≥ 1:320 were associated with a lower likelihood of requiring biopsy. LGB-positive patients more frequently showed non-specific inflammatory or immunologic abnormalities, including higher erythrocyte sedimentation rate, elevated serum IgG, and higher antinuclear antibody titers (≥ 1:320). CONCLUSION: LGB may provide supportive information as part of the diagnostic work-up in selected patients with suspected Neuro-Sjögren, particularly when serological findings are negative or inconclusive. Associations with LGB requirement should be interpreted in the context of the center-specific diagnostic pathway and should not be regarded as universal indications for biopsy.