Diagnostic Value of Revised Diagnostic Criteria for Thromboangiitis Obliterans (Buerger's Disease): A Cross-sectional Study

Three deficiencies of the Papa criteria (point scoring system, PSS) for thromboangiitis obliterans (TAO) were identified and updated. According to the new criteria, 185 patients with clinically diagnosed TAO in a single center using the diagnostic criteria of Shionoya were scored and re-diagnosed. The diagnostic criteria of The Japanese Ministry of Health, Labour and Welfare (JMHLW) were used as the comparative standard to compare the diagnostic value of the revised PSS (RPSS) criteria in the diagnosis of TAO. Among the 185 patients, 145 patients were possibly diagnosed with TAO by the RPSS diagnostic criteria, 40 patients were excluded from TAO diagnosis. The JMHLW standard definitively diagnosed 154 patients with TAO, and 31 patients were excluded from TAO diagnosis. Compared with the JMHLW standard, the accuracy of the RPSS diagnostic criteria was 0.90, and the Kappa value was 0.67 (Confidence interval [CI]: 0.53-0.81), which reached "substantial" agreement. The Area Under Curve (AUC) was 0.86 and >0.7, showing good diagnostic value. The RPSS criteria have good diagnostic efficacy. If this revised scoring system can be endorsed, it might improve the certainty of TAO diagnosis and research.