What is a focus score?


The focus score is a number used by pathologists to describe how much inflammation is present in a minor salivary gland biopsy. It helps doctors determine whether the changes in the glands are consistent with an autoimmune condition such as Sjögren syndrome, a disease in which the body’s immune system attacks its own salivary and tear glands.

How is the focus score calculated?

When a small sample of salivary gland tissue is examined under the microscope, the pathologist looks for foci—small, round clusters of white blood cells called lymphocytes.

  • Each focus is defined as an area containing at least 50 lymphocytes.

  • The number of foci is then divided by the total area of salivary gland tissue (measured in square millimeters).

  • Finally, the result is multiplied by 4 to standardize the score to 4 mm² of tissue.

Focus score = (Number of foci ÷ Area of glandular tissue in mm²) × 4

For example, a biopsy that contains 2 foci in 4 mm² of tissue would have a focus score of 2 ÷ 4 × 4 = 2.

What does the focus score mean?

  • A focus score of 1 or higher means there is one or more clusters of lymphocytes for every 4 mm² of salivary gland tissue.

  • This level of inflammation supports a diagnosis of Sjögren syndrome when combined with other findings, such as dry mouth, dry eyes, or positive blood tests (anti-SSA/Ro or anti-SSB/La antibodies).

  • A focus score below 1 means the amount of inflammation is mild and not typical of Sjögren syndrome.

The focus score is only one part of the overall evaluation. Your doctor will consider it together with your symptoms, physical examination, and blood test results.

Are there other features the pathologist looks for?

Yes. In addition to counting lymphocytic foci, the pathologist will:

  • Confirm that the inflammation is within the salivary gland lobules (not only around ducts or blood vessels).

  • Assess the number of lobules to ensure the biopsy is adequate (usually at least five).

  • Look for tissue damage, such as loss of acini (the small clusters of cells that produce saliva).

These findings, taken together, help determine whether the changes are consistent with an autoimmune process.

What should I discuss with my doctor?

If your pathology report includes a focus score:

  • Ask your doctor how this finding fits with your symptoms and blood test results.

  • Discuss whether you meet the criteria for Sjögren syndrome or another autoimmune disease.

  • Discuss the potential treatments or additional tests that may be recommended.

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