Standardization of Synovial Biopsies Procedures across Centers: A Consensus Initiative Using a Delphi Survey

Aurélie Najm^1,2, Benoît Le Goff MD PhD^3,4, Carl Orr⁵, Rogier Thurlings⁶, Juan D. Cañete⁷, Frances Humby⁸, Stefano Alivernini⁹, Søren Andreas Just¹⁰, Vasco C. Romão¹¹, Veit Krenn¹², Ulf Müller-Ladner¹³, Olga Addimanda¹⁴, Antonio Manzo¹⁵, Sander W. Tas¹⁶, Patrick Durez¹⁷, Laurent Meric de Bellefon¹⁷, Maria Stoenoiu¹⁸, Vibeke Strand¹⁹, Mihir D Wechalekar²⁰, João E. Fonseca²¹, Bernard R. Lauwerys²² and Douglas J. Veale²³, ¹INSERM U1238 University of medicine, PHY-OS Laboratory, Nantes, France, ²Department of Rheumatology, Nantes University Hospital, Nantes, France, ³Rheumatology, Nantes University Hospital, Nantes, France, ⁴UNR1238 University of medicine, PHY-OS Laboratory, Nantes, France, ⁵Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, University College Dublin, Dublin 4, Ireland, ⁶Rheumatology, Radboud university medical center, Nijmegen, Netherlands, ⁷Rheumatology Deparment, Hospital Clinic and IDIBAPS, Barcelona, Spain, Barcelona, Spain, ⁸Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom, ⁹Division of Rheumatology - Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, Rome, Italy, ¹⁰Department of Rheumatology, Department of Rheumatology, Odense University Hospital, Odense, Denmark, Odense, Denmark, ¹¹Rheumatology Department, Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHLN, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal, ¹²Zytologie und Molekulare Diagnostik, MVZ-Zentrum für Histologie, Trier, Germany, ¹³Dept. of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Germany, Bad Nauheim, Germany, ¹⁴Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, Bologna, ., Italy, ¹⁵Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy, ¹⁶Clinical Immunology & Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, Netherlands, ¹⁷Rheumatology, Rheumatology - Cliniques universitaires Saint-Luc - Université Catholique de Louvain - Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium, ¹⁸Rheumatology - Cliniques universitaires Saint-Luc - Université Catholique de Louvain - Institut de Recherche Expérimentale et Clinique (IREC), Bruxelles, Belgium, ¹⁹Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, ²⁰Royal Adelaide Hospital, Adelaide, Australia, ²¹Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHLN, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal, ²²Department of Rheumatology, Rheumatology - Cliniques universitaires Saint-Luc - Université Catholique de Louvain - Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium, ²³Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, University College Dublin, Dublin, Ireland

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: biopsies, histopathologic and synovitis, Synovial Immune Biology

Session Information

Date: Monday, October 22, 2018

Session Title: Rheumatoid Arthritis – Etiology and Pathogenesis Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Synovial biopsies are increasingly performed in both clinical setting and translational research. Synovial tissue analysis role in prediction of response to treatment is to be yet considered and regarding that most studies involve multicentric participation, an unmet need is the standardization of synovial biopsies procedures.

The aim of this collaborative work was to create a consensual set of items for handling and analysis of synovial biopsies in clinical practice and

translational research.

Methods: EULAR Synovitis Study Group (ESSG) and Synovial Tissue Special Interest Group (SIG) members were consulted through a Delphi survey. 3 sequential rounds occurred between June 2016 and June 2017. The items were identified and formulated based on a comprehensive literature review. Members were sent a written questionnaire containing items divided in 2 parts. The first part of the questionnaire referred to clinical practice containing 5 subsections: biopsy sampling, biopsy handling, histological analysis, staining and immunohistochemistry (IHC), biopsy analysis and pathologistÕs report. The second part referred to translational research and contained 6 subsections (same 5 plus RNA analysis).

Every participant was asked to score each item with a 5 points Likert (0: strongly disagree, 5: strongly agree), comments were allowed for each item. Items with a median score above 3.5 on 5 and a percentage of agreement above 70% were for the next round. Items with lower score were either suppressed of modified according to participantsÕ comments. Anonymized detailed results were circulating through participants between each round. Last round occurred orally at ESSG meeting in June 2017.

Results: 27 ESSG members from 19 centers were contacted by email. 20 participants from 17 centers answered (response rate of 74%). Response rates for next rounds were 100%. First questionnaire contained 44 items for Part 1 Clinical practice and 43 items for the second part about translational research. The flow chart is described in Figure 1. Third oral round allowed to obtain a final set of items unanimously (Figure 2).

Conclusion: We hereby propose a set of consensual points to consider on analysis of synovial biopsies in clinical practice and translational research to be further used in multicentric clinical trials and therefore ensure reliability.

Disclosure: A. Najm, None; B. Le Goff MD PhD, None; C. Orr, None; R. Thurlings, None; J. D. Cañete, None; F. Humby, None; S. Alivernini, None; S. A. Just, None; V. C. Romão, None; V. Krenn, None; U. Müller-Ladner, None; O. Addimanda, None; A. Manzo, None; S. W. Tas, AbbVie, AstraZeneca, Bristol-Myers Squibb, Celgene, MSD, Pfizer Inc, Roche, Sobi, UCB, 2; P. Durez, BMS, Lilly, Sanofi, Pfizer, 8; L. Meric de Bellefon, None; M. Stoenoiu, None; V. Strand, None; M. D. Wechalekar, None; J. E. Fonseca, AbbVie Inc., 2, 8,Pfizer, Inc., 2, 8,Merck & Co., 2, 8,Bayer, 2, 8,Janssen, 2, 8,Roche, 2, 8,UCB, Inc., 2,Novartis, 2, 8; B. R. Lauwerys, None; D. J. Veale, None.

To cite this abstract in AMA style:

Najm A, Le Goff MD PhD B, Orr C, Thurlings R, Cañete JD, Humby F, Alivernini S, Just SA, Romão VC, Krenn V, Müller-Ladner U, Addimanda O, Manzo A, Tas SW, Durez P, Meric de Bellefon L, Stoenoiu M, Strand V, Wechalekar MD, Fonseca JE, Lauwerys BR, Veale DJ. Standardization of Synovial Biopsies Procedures across Centers: A Consensus Initiative Using a Delphi Survey [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/standardization-of-synovial-biopsies-procedures-across-centers-a-consensus-initiative-using-a-delphi-survey/. Accessed January 31, 2023.

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