What is a focus score?

Reviewed by Pathologists on:
January 9, 2026

A focus score is a measurement used by pathologists to describe the amount of inflammation seen in a minor salivary gland biopsy. It is most commonly used when doctors are evaluating for Sjögren syndrome, an autoimmune disease that affects moisture-producing glands.

The focus score quantifies the number of immune cell clusters present in the tissue and whether the inflammatory pattern supports a specific diagnosis.

What is a “focus”?

In pathology, a focus refers to a tight cluster of immune cells, mainly lymphocytes, seen under the microscope. These clusters represent areas where the immune system is actively attacking the gland tissue.

For the purpose of calculating a focus score, a focus is defined as a group of at least 50 lymphocytes located next to normal-appearing salivary gland tissue.

How is the focus score calculated?

The focus score is calculated by counting the number of foci and adjusting for the amount of gland tissue examined. Specifically, it is reported as the number of foci per 4 square millimeters of salivary gland tissue.

This standardization allows results to be compared fairly, even if different biopsy samples contain various amounts of tissue.

What does the focus score mean?

The focus score helps determine whether the pattern of inflammation is significant.

• A focus score less than 1 means that few or no immune cell clusters were seen.

• A focus score of 1 or greater means that one or more significant clusters were present.

A focus score of 1 or higher is considered supportive of Sjögren syndrome when interpreted together with symptoms, blood tests, and other clinical findings.

Why is the focus score important?

The focus score provides objective evidence of immune-mediated damage to the salivary glands. It helps doctors:

• Support or exclude a diagnosis of Sjögren syndrome.

• Distinguish autoimmune inflammation from other causes of gland irritation.

• Understand the severity and pattern of gland involvement.

The focus score is not used alone to make a diagnosis. It is always interpreted in the context of symptoms such as dry eyes or dry mouth, blood test results, and imaging studies.

Are all inflammatory cells counted in the focus score?

No. Only specific clusters of lymphocytes are counted. Scattered immune cells, inflammation caused by infection, scarring, or tissue damage, are not included in the focus score.

This distinction is vital because salivary glands can show mild inflammation for many reasons unrelated to autoimmune disease.

What does a normal focus score look like?

In a normal salivary gland biopsy, there are few immune cells, and they are usually scattered rather than clustered. In this situation, the focus score is 0.

Why might the focus score be mentioned in my pathology report?

The focus score is included when a salivary gland biopsy is performed to evaluate dry mouth, dry eyes, or suspected autoimmune disease. The score helps explain whether the biopsy shows changes consistent with Sjögren syndrome or another inflammatory condition.

Your pathology report may also describe other features, such as scarring, fat replacement, or duct changes, which provide additional context for the focus score.

Is a higher focus score more severe?

A higher focus score means more immune cell clusters were seen in the tissue sample. While this suggests more active inflammation, it does not always correlate directly with symptom severity. Some people with higher focus scores have mild symptoms, while others with lower scores may have significant dryness.

Questions to ask your doctor

• What was my focus score?

• Does this score support a diagnosis of Sjögren syndrome?

• Were other inflammatory changes seen in the biopsy?

• How do these findings fit with my symptoms and blood tests?

• Do I need additional tests or follow-up?