| 제목 |
Prospective Validation of the FEES-Tensilon Test |
| 소속 |
The Catholic University of Korea Bucheon St. Mary`s Hospital , Department of Rehabilitation Medicine1, Department of Neurology with Institute of Translational Neurology, University of Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany, Department Neurology2 |
| 저자 |
Sun Im1*†, Tobias Warnecke2, Rainer Dziewas2 |
Objective: The FEES-Tensilon Test (FTT) was developed to diagnose myasthenia gravis (MG) in patients with unclear pharyngeal dysphagia and has been proven to show an excellent inter- and intra-rater reliability. However, its diagnostic accuracy has not yet been further investigated. The purpose of this prospective study was, therefore, to determine sensitivity and specificity of the FTT and compare its diagnostic validity to other diagnostic markers commonly used in the diagnosis of MG.
Methods: A total of 100 patients with unclear pharyngeal dysphagia were recruited. All patients were prospectively subjected to FTT and subsequently followed up clinically. The FTT was considered positive if a significant improvement of pharyngeal swallowing function could be objectified endoscopically upon administration of edrophonium.Also, repetitive nerve stimulation (RNS) tests and serum MG antibody analysis were conducted. The final diagnosis of MG was established either by a positive laboratory test for specific autoantibodies, i.e. serum anti-acetylcholine receptor (Ach-R) antibodies or serum anti-muscle-specific kinase (MuSK) antibodies.
Results: All subjects (mean age=62.5 ± 14.1 years, gender(missing)) underwent the FTT without any complications. Fifty-one patients were finally diagnosed with MG.
Serum antibody tests showed sensitivity levels of 94% with a total of 48 patients testing positive for the serum antibody tests, that included either or both of the acetylcholine receptor antibody, MUSK or titin antibodies. RNS results were positive in 26 patients (50.9%) Seventeen patients (65.4%) showed a positive decrement response in the M. nasalis. Three patients (11.5%) in the M. trapezius and six patients (23.1%) in both of the tested muscles. The RNS showed sensitivity levels of 51%.
In contrast the FTT were positive in 45 (88%) of the patients with sensivity levels of 88.2% and 95.9%, respectively [area under the receiver operating characteristic curve (AUROC): 0.92,95% CI: 0.85-0.97, p< 0.0001]. This AUROC was comparable to the AUROC obtained from the serum antibody tests (AUROC=0.97; 95% CI, 0.93-1.0; P=0.097), but was statistically higher compared to the AUROC from the RNS results (AUROC= 0.75; 95% CI, 0.68-0.82; P<0.001) and the clinical fatiguable swallowing test (AUROC= 0.75; 95% CI, 0.68-0.82; P<0.001).
Interpretation: The FTT has excellent clinical properties to be routinely used in the assessment of dysphagia in unclear cases with isolated or predominant pharyngeal muscle involvement allowing rapid and accurate diagnosis of MG. |
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Receiver operating characteristic curve analysis for the Fees-Tensilon Test and the other assessment methods
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