Session Information
Session Title: Sjögren's Syndrome: Clinical Aspects
Session Type: Abstract Submissions (ACR)
Background/Purpose: : Histopathologic evaluation of minor labial salivary gland (MLSG) is a major goal for the classification of patients with a primary Sjögren syndrome (pSS) 1,2. The standard focus score has been described by Daniels et al 3 but several other histopathological abnormalities have been described. However, their intra and inter reliabilities have been poorly investigated.
Our objective was to examine associations between MLSG histopathology and their reliabilities in the TEARS (Tolerance and efficacy of Rituximab in primary Sjogren Syndrome) study, a randomised multicenter study evaluating efficacy of rituximab in pSS. We studied inter and intra-observer agreement concerning the focus score and other histopathological items. We also tested agreement in the estimation of B and T cells lymphocytes ratio using doubled staining immunohistochemistry.
Methods: All MLSG biopsies available from the TEARS study were reviewed and scored by an independent pathologist (SC) at two different times, after a training session (SC, IQR). All patients fulfilled the American-European Consensus Group criteria for pSS, and had an active disease. We compared with the baseline focus score, established at the patient’s inclusion. We used Daniels et al’s protocol to re-evaluate the MLSG. As previously described, the agreement rate was calculated for the dichotomized focus score (separating focus <1 from ≥ 1/4mm2) and for each following item: focal lymphocytic sialadenitis, non-specific chronic inflammation, presence of confluent foci, presence of germinal centers, acinar depletion, duct dilatation, fibrosis, and adiposis. B and T lymphocytes cells ratio was also measured after double staining in immunohistochemistry. Inter and intra-observer agreements were estimated using the kappa index.
Results:
Inter observer reliabilities were evaluated in 77 MLSG biopsies and intra observer in 89 independant MLSG biopsies. MLSG specimens included 50% with focal lymphocytic sialadenitis and 41 % with non-specific or sclerosing chronic sialadenitis. For the dichotomized focus score, the inter-observer agreement was good k = 0.70 (95% CI 0.62-0.78). 66/77(86%) MLSG biopsies had concordant focus scores. For focal lymphocytic sialadenitis, non-specific chronic inflammation and fibrosis, reliabilities were moderate, respectively, k = 0.63 (95% CI 0.54-0.72); 0.42(95% CI 0.33-0.51) and 0.22 (95% CI 0.13-0.33). Intra observer reliabilities for focus score was good with a k = 0.77 (95% CI 0.71-0.84). Reliability for fibrosis was moderate, k= 0.44 (95% CI 0.34-0.53). The agreement for B/T lymphocyte ratio was excellent k = 0.87 (95% CI 0.82-0.92).
Conclusion:
Although focus score reliability seems good, there is disparity in the way to determine the focus score. Daniels et al’ s protocol fails to be systematically applied. This could result in an over estimation of the focus score. Evaluation of B and T cells infiltrate is accurate.
Disclosure:
S. Costa,
None;
I. Quintin Roue,
None;
A. Lesourd,
None;
S. Jousse-Joulin,
Roche Pharmaceuticals,
5;
P. Marcorelles,
None;
E. Hachulla,
None;
V. Goeb,
None;
M. C. Copin,
None;
J. M. Berthelot,
None;
J. O. Pers,
None;
O. Vittecoq,
None;
E. Nowak,
None;
A. Saraux,
Roche Pharmaceuticals,
2,
Roche Pharmaceuticals,
5;
V. Devauchelle-Pensec,
Roche Pharmaceuticals,
5,
Roche Pharmaceuticals,
5.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/multicentric-analysis-of-inter-and-intra-observer-reliabilities-for-histopathological-abnormalities-in-salivary-gland-biopsy-in-primary-sjogren-syndrome/