Center for Skin Blistering Diseases, Department of Dermatology, University of Groningen, University Medical Center Groningen, Hanzeplein, 9700 RB Groningen, the Netherlands.
Br J Dermatol. 2013 Jul;169(1):100-5. doi: 10.1111/bjd.12308.
Serration pattern analysis of direct immunofluorescence (DIF) allows the differentiation of epidermolysis bullosa acquisita from other subtypes of pemphigoid. In daily practice its use is limited due to lack of experience and unfamiliarity.
To test the learnability of DIF serrated-pattern recognition in groups with various a priori levels of competence.
An online nversusu-test (www.nversusu.umcg.nl) was created, which contained 26 DIF images of the epidermal basement membrane zone, IgG stained and photographed with a magnification of × 40 and × 63. All images represented patients with a form of subepidermal autoimmune bullous disease. Thirteen DIF images were presented before and 13 DIF images after an instruction video about n- and u-serrated patterns. There were three options to choose from: n-serrated, u-serrated or undetermined. The test was completed by three groups of professionals: dermatology residents in training at the University Medical Center Groningen (UMCG), international experts on bullous diseases, and dermatologists and pathologists who had participated in the Groningen blistering course during the past 10 years.
The overall number of correct answers of serration patterns was significantly higher after instruction than before instruction (median 9.0 correct answers vs. 11.0 correct answers, P < 0.001). Participants showed a mean improvement after instruction of 15.4% in the UMCG group (66.7% vs. 82.1%), 16.2% in the international expert group (67.2% vs. 83.4%) and 12.1% in the blistering course group (60.7% vs. 72.8%). The u-serrated pattern was better recognized than the n-serrated pattern.
Serration pattern analysis by DIF can be learned irrespective of background of expertise.
直接免疫荧光（DIF）的锯齿状模式分析可将获得性大疱性表皮松解症与其他类别的天疱疮区分开来。但在日常实践中，由于缺乏经验和不熟悉，其应用受到限制。
测试不同专业背景的人群对 DIF 锯齿模式识别的可学习性。
创建了一个在线 nversusu 测试（www.nversusu.umcg.nl），其中包含 26 张表皮基底膜区 IgG 染色的 DIF 图像，放大倍数为×40 和×63。所有图像均代表患有亚表皮自身免疫性大疱性疾病的患者。在观看有关 n-和 u-锯齿模式的教学视频之前，展示了 13 张 DIF 图像，之后又展示了 13 张。有 n-锯齿、u-锯齿和不确定三种选择。该测试由三组专业人员完成：格罗宁根大学医学中心（UMCG）的皮肤科住院医师、天疱疮国际专家，以及过去 10 年参加过格罗宁根水疱病课程的皮肤科医生和病理学家。
指导后锯齿模式的总正确答案数明显高于指导前（中位数 9.0 个正确答案 vs. 11.0 个正确答案，P<0.001）。UMCG 组的指导后平均提高了 15.4%（66.7% vs. 82.1%），国际专家组提高了 16.2%（67.2% vs. 83.4%），水疱病课程组提高了 12.1%（60.7% vs. 72.8%）。u-锯齿模式比 n-锯齿模式更容易识别。
DIF 的锯齿状模式分析可在不考虑专业背景的情况下进行学习。
