Hiromasa Takei, Mototoshi Kato, Satoko Yamagishi, Yohei Yamada, Motohiro Kano, Yoshiaki Kinoshita, Michio Ozeki, Shunsuke Nosaka, Takeshi Hirabayashi, Naonori Kawakubo, Tomoro Hishiki, Keita Terui, Tomoaki Taguchi, Shigeru Ueno, Akihiro Fujino
The SHALL-WE score defines when sclerotherapy is unlikely to succeed and treatment escalation should be considered. Prospective external validation is warranted.
PURPOSE: No standardized tool guides the decision of when to escalate beyond sclerotherapy in lymphatic malformations (LMs). We developed the SHALL-WE score (Severity, Histology, And Location-Lymphatic malformation: When to Escalate) to define the optimal sclerotherapy threshold in superficial LMs.
METHODS: We analyzed 709 patients with superficial LMs from a nationwide survey in Japan. Multivariable logistic regression identified predictors of treatment success, used to construct the SHALL-WE score (0-3 points): head and neck location, non-cystic histology, and severe disease (1 point each). The optimal threshold was the session count beyond which success rates fell below the overall mean (63.0%).
RESULTS: Treatment success rates decreased with increasing score (score 0: 71.6%, 1: 64.1%, 2: 43.6%, 3: 20.0%; p < 0.001). Optimal thresholds were two sessions for score 0, one for score 1, and early escalation for scores 2-3. Patients managed within thresholds had higher success rates (71.9% vs. 51.2%; adjusted OR 1.921, 95% CI 1.340-2.753, p < 0.001).
CONCLUSION: The SHALL-WE score defines when sclerotherapy is unlikely to succeed and treatment escalation should be considered. Prospective external validation is warranted.