Objective:

This study aimed to evaluate the positivity rate of minor salivary gland biopsy (MSGB), identify neurological predictors, and assess its contribution to differential diagnosis in patients jointly assessed by the neurology and rheumatology departments.

Background:

While clinical and laboratory evaluations are often sufficient to diagnose neuroimmunological disorders, additional methods may be required in selected cases to clarify the diagnosis. MSGB is a commonly used diagnostic tool in rheumatologic diseases, but its role in patients presenting with neurological manifestations has not been clearly established.

Design/Methods:

We retrospectively reviewed patients hospitalized in the Neurology Department of Hacettepe University between 2014 and 2024 who underwent rheumatologic consultation and MSGB. Demographic, clinical, laboratory, and imaging data were extracted from hospital records. A biopsy was considered positive if the focus score was ≥1 and/or the Chisholm–Mason grade was 3–4.

Results:

A total of 323 patients were included (mean age 50.6 ± 15.2 years; 69.7% female). MSGB was positive in 41 patients (12.7%). In these patients, xerostomia, xerophthalmia, lymphadenopathy, and anti-La antibody positivity were significantly more common. Neurologically, deep sensory loss, ocular movement restriction, long-segment spinal involvement, and leptomeningeal enhancement were associated with biopsy positivity. Multivariate analysis identified xerostomia (OR 3.27), deep sensory loss (OR 4.29), anti-La positivity (OR 9.72), long-segment spinal involvement (OR 2.40), and leptomeningeal involvement (OR 3.06) as independent predictors. A significant correlation was observed between neurological and rheumatologic diagnoses (rho = 0.552, p < 0.001).

Conclusions:

Minor salivary gland biopsy can offer valuable diagnostic information in patients presenting with neurological findings, especially when deep sensory loss or long-segment myelitis is present. In this cohort, its contribution extended beyond rheumatologic assessment, supporting the diagnostic process in complex neuroimmunological cases. The results emphasize the practical benefit of integrating MSGB into a multidisciplinary evaluation framework.