Do you always perform salivary gland biopsy to confirm the diagnosis In patients with suspected seronegative Sjogren's syndrome?

I often struggle with the decision of obtaining a biopsy in suspected Sjogren's in a person who is seronegative, when the main issue is dryness, and the main reason is that I wonder if it will make a difference in management.

When I was a Rheumatology fellow, I was taught to give Hydroxychloroquine ...

No, but MSGB (minor salivary gland biopsy) can provide useful information, in addition to supporting the clinical diagnosis of Sjogren's disease (SjD), if the Focus Score is 3-4 or greater, the risk of lymphoma development is higher.

For patients, if they are SSA/SSB negative, they often report havi...