Evidence map›Paper›PMID 42753001›Full record

ArticlePediatric surgery international2026

Shall we score? The SHALL-WE score for optimizing sclerotherapy in superficial lymphatic malformations.

Hiromasa Takei, Mototoshi Kato, Satoko Yamagishi, Yohei Yamada, Motohiro Kano, Yoshiaki Kinoshita, Michio Ozeki, Shunsuke Nosaka, Takeshi Hirabayashi, Naonori Kawakubo and 5 more

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Article in Pediatric surgery international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

15 authors.

Hiromasa TakeiDepartment of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
Mototoshi KatoDepartment of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
Satoko YamagishiDepartment of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
Yohei YamadaDepartment of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
Motohiro KanoDepartment of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
Yoshiaki KinoshitaDepartment of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Michio OzekiDepartment of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan.
Shunsuke NosakaDepartment of Radiology, National Center for Child Health and Development, Tokyo, Japan.
Takeshi HirabayashiDepartment of Pediatric Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Naonori KawakuboDepartment of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Tomoro HishikiDepartment of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Keita TeruiDivision of Pediatric Surgery, Department of Surgery, Jichi Medical University, Tochigi, Japan.
Tomoaki TaguchiFukuoka College of Health Science, Fukuoka, Japan.
Shigeru UenoOkamura Isshindow Hospital, Okayama, Japan.
Akihiro FujinoDepartment of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan. a.fujino@keio.jp.

Funding

Japan Agency for Medical Research and Development（AMED） JP25ek0109698Ministry of Health, Labour and Welfare JPMH23FC1028Ministry of Health, Labour and Welfare, Japan JPMH23FC1051Wellcome Trust FC001051
6 · The paper itself

Abstract

purposeNo 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.

methodsWe 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%).

resultsTreatment 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).

conclusionThe SHALL-WE score defines when sclerotherapy is unlikely to succeed and treatment escalation should be considered. Prospective external validation is warranted.

Indexed as

Lymphatic AbnormalitiesSclerotherapyFemaleHumansInfantJapanMaleRetrospective StudiesSeverity of Illness IndexTreatment OutcomeLymphatic malformationSclerotherapySHALL-WE scoreSurgeryTherapeutic optionsTreatment algorithm

Identifiers

PMID42753001
PMCPMC13585900

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