Clinical assessment determines the diagnosis of inclusion body myositis independently of pathological features

Brady, Stefen; Squier, Waney; Hilton‐Jones, David

doi:10.1136/jnnp-2013-305690

Cited by 67 publications

(57 citation statements)

References 23 publications

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“…[2]. In the case of IBM all patients fulfilled the clinical and histopathologic criteria for definite IBM according to Griggs et al [20] and the 2011 proposed ENMC criteria for clinicopathologically defined IBM [21].…”

Section: Mhc-i Is Expressed But Is Undetectable Immunohistochemicallymentioning

confidence: 99%

An analysis of the sensitivity and specificity of MHC-I and MHC-II immunohistochemical staining in muscle biopsies for the diagnosis of inflammatory myopathies

Cruz

Luo

Miller

et al. 2014

Neuromuscular Disorders

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MURDOCH RESEARCH REPOSITORYThis is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Abstract 1 Abstract 3 AbstractAlthough there have been several previous reports of immunohistochemical staining for MHC antigens in muscle biopsies, there appears to be a lack of consensus about its routine use in the diagnostic evaluation of biopsies from patients with suspected inflammatory myopathy. Positive MHC-I staining is nonspecific but is widely used as a marker for inflammatory myopathy, while the role of MHC-II staining is not clearly defined. We investigated the sensitivity and specificity of MHC-I and II immunostaining for the diagnosis of inflammatory myopathy in a large group of biopsies from a single reference laboratory. Positive staining for MHC-I was found to have a high sensitivity in biopsies from patients with inflammatory myopathy but a very low specificity, as it was also common in other non-inflammatory myopathies and neurogenic disorders.On the other hand, MHC-II positivity had a much higher specificity in all major subgroups of inflammatory myopathy, especially inclusion body myositis. The findings indicate that the combination of MHC-I and MHC-II staining results in a higher degree of specificity for the diagnosis of inflammatory myopathy and that in biopsies with inflammation, positive MHC-II staining strongly supports the diagnosis of an immunemediated myopathy. We recommend that immunohistochemical staining for both MHC-I and MHC-II should be included routinely in the diagnostic evaluation of muscle biopsies from patients with suspected inflammatory myopathy. However, as the sensitivity and interpretation of MHC staining may depend on the technique used, further studies are needed to compare procedures in different centres and develop standardised protocols.Abstract 4

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Section: Mhc-i Is Expressed But Is Undetectable Immunohistochemicallymentioning

confidence: 99%

An analysis of the sensitivity and specificity of MHC-I and MHC-II immunohistochemical staining in muscle biopsies for the diagnosis of inflammatory myopathies

Cruz

Luo

Miller

et al. 2014

Neuromuscular Disorders

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“…Although these pathologic features, in addition to recently identified biomarkers such as p62 and TDP-43 (TAR DNA-binding protein-43) immunoreactivity, might be more frequently present in specialized research laboratories, their performance by clinical pathology laboratories in the course of clinical care is uncommon. Nevertheless, the use of these specialized pathologic features in the MRC 2010 PD category, which has been advocated for use in clinical trials, 9,13 and the ENMC 2013 CPD may be limiting in that only 11% and 15% of 200 patients with IBM fulfill these categories' criteria, respectively.…”

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confidence: 99%

“…13 This study used different criteria for several categories than we did. Their Griggs possible category 5 required rimmed vacuoles as an inclusion criterion, which we did not require.…”

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confidence: 99%

“…13 Herein, we have shown that such criteria can be empirically derived in a principled fashion directly from patient data through the use of unbiased machine learning approaches. Such data-derived criteria performed well in our cohort with 90% sensitivity and 96% specificity, although we recognize that some patients with severe inflammatory myopathies or inherited vacuolar myopathy may meet these criteria.…”

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confidence: 99%

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Evaluation and construction of diagnostic criteria for inclusion body myositis

et al. 2014

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Objective: To use patient data to evaluate and construct diagnostic criteria for inclusion body myositis (IBM), a progressive disease of skeletal muscle. Methods:The literature was reviewed to identify all previously proposed IBM diagnostic criteria.These criteria were applied through medical records review to 200 patients diagnosed as having IBM and 171 patients diagnosed as having a muscle disease other than IBM by neuromuscular specialists at 2 institutions, and to a validating set of 66 additional patients with IBM from 2 other institutions. Machine learning techniques were used for unbiased construction of diagnostic criteria.Results: Twenty-four previously proposed IBM diagnostic categories were identified. Twelve categories all performed with high ($97%) specificity but varied substantially in their sensitivities (11%-84%). The best performing category was European Neuromuscular Centre 2013 probable (sensitivity of 84%). Specialized pathologic features and newly introduced strength criteria (comparative knee extension/hip flexion strength) performed poorly. Unbiased data-directed analysis of 20 features in 371 patients resulted in construction of higher-performing data-derived diagnostic criteria (90% sensitivity and 96% specificity).Conclusions: Published expert consensus-derived IBM diagnostic categories have uniformly high specificity but wide-ranging sensitivities. High-performing IBM diagnostic category criteria can be developed directly from principled unbiased analysis of patient data. Classification of evidence:This study provides Class II evidence that published expert consensusderived IBM diagnostic categories accurately distinguish IBM from other muscle disease with high specificity but wide-ranging sensitivities.

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“…It remains frequently misdiagnosed as other neuromuscular conditions by health care professionals. The degenerative processes with amyloid accumulation distinguish sporadic inclusion body myositis from other inflammatory myopathies (5). Muscle biopsy, with the presence of characteristic structures such as rimmed vacuoles and amyloid deposits, using Congo red technique, definitely confirm IBM (5,6).…”

Section: Miozitis Sa Inkluzivnim Telašcima Pripada Grupi Idiopatskih mentioning

confidence: 99%

Difficulties in the Diagnosis of Inclusion Body Myositis-Case Report

Bazic

Todorović

Tončev

et al. 2019

Serbian Journal of Experimental and Clinical Research

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Clinical assessment determines the diagnosis of inclusion body myositis independently of pathological features

Cited by 67 publications

References 23 publications

An analysis of the sensitivity and specificity of MHC-I and MHC-II immunohistochemical staining in muscle biopsies for the diagnosis of inflammatory myopathies

An analysis of the sensitivity and specificity of MHC-I and MHC-II immunohistochemical staining in muscle biopsies for the diagnosis of inflammatory myopathies

Evaluation and construction of diagnostic criteria for inclusion body myositis

Difficulties in the Diagnosis of Inclusion Body Myositis-Case Report

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