title: Reliability of histopathological salivary gland biopsy assessment in Sjögren's syndrome: a multicentre cohort study.
abstract: OBJECTIVE
  The aim of this study was to assess intraobserver and interobserver reliability of minor salivary gland biopsy (MSGB) in SS.
  
  
  METHODS
  All MSGBs available from the Tolerance and Efficacy of Rituximab in Primary Sjögren's Syndrome (TEARS) study were subjected to a standardized blinded assessment by a single specifically trained pathologist twice at a 2 month interval; both the Chisholm-Mason (CM) grade and the focus score (FS) were determined. Baseline histopathological reports by local pathologists at each study centre were compared with the first standardized blinded assessment. Agreement was assessed for the dichotomized FS (dFS) and dichotomized CM (dCM) grade, as well as for nine other histopathological features.
  
  
  RESULTS
  Eighty-nine MSGBs were studied. Intraobserver κ values were 1 for dFS, 0.80 for dCM, 0.67 for germinal centre-like structures, 0.44 for fibrosis and 0.29 for confluent foci. Most of the local histopathological reports based their diagnosis on the CM grade, although the FS was often reported or the data needed to determine it were provided. Interobserver agreement κ values were 0.71 for dFS, 0.64 for dCM, 0.46 for focal lymphocytic sialadenitis, 0.42 for non-specific chronic inflammation and 0.16 for fibrosis.
  
  
  CONCLUSIONS
  Although FS reliability was good, disparities were noted in the assessment methods used by local pathologists. The protocol for FS determination was not followed routinely, with the result that the FS was often overestimated. Germinal centre-like structures, which predict lymphoma, showed good reliability but were inconsistently reported.
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Costa
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Quintin-Roué
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Lesourd
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jousse-Joulin
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Berthelot
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Hachulla
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Hatron
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Goeb
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Vittecoq
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Jacques Olivier
authors.initials: JO
authors.lastname: Pers
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Marcorelles
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Nowak
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.affiliation: Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France Pathology Department, Brest University Hospital, Brest, France, Pathology Department, Vannes General Hospital, Vannes, Brest Occidental University, Rheumatology Unit, Hôpital de la Cavale Blanche, EA 2216, ESPRI 29, Brest University, Brest, Rheumatology Department, Hôtel Dieu University Hospital, Nantes, Department of Internal Medicine, Nord-de-France University, Claude-Huriez Hospital, Lille, Rheumatology Department, Rouen University Hospital, Rouen and Brest Occidental University, Clinical Investigation Centre, Institut National de la Santé et de la Recherche Médicale, Brest, France valerie.devauchelle-pensec@chu-brest.fr.
authors.forename: Valérie
authors.initials: V
authors.lastname: Devauchelle-Pensec
mesh_terms: D001706:Biopsy / Q000706:statistics & numerical data; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results; D012470:Salivary Glands, Minor / Q000473:pathology*; D012859:Sjogren's Syndrome / Q000473:pathology*
keywords: Chisholm; Sjögren’s syndrome; focus score; minor salivary gland biopsy; reliability