Department of Dermatology, Center for Blistering Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Dermatology, University of Lübeck, Lübeck, Germany.
J Am Acad Dermatol. 2018 Apr;78(4):754-759.e6. doi: 10.1016/j.jaad.2017.11.029. Epub 2017 Nov 16.
Direct immunofluorescence (DIF) microscopy of a skin biopsy specimen is the reference standard for the diagnosis of pemphigoid diseases (PDs). Serration pattern analysis enables the differentiation of epidermolysis bullosa acquisita (EBA) from other PDs using DIF microscopy alone. However, practice gaps need to be addressed in order to implement this technique in the routine diagnostic procedure.
We sought to determine and optimize the technical requirements for serration pattern analysis of DIF microscopy and determine interrater conformity of serration pattern analysis.
We compared serration pattern analysis of routine DIF microscopy from laboratories in Groningen, The Netherlands and Lübeck, Germany with 4 blinded observers. Skin biopsy specimens from 20 patients with EBA and other PDs were exchanged and analyzed. Various factors were evaluated, including section thickness, transport medium, and biopsy specimen processing.
The interrater conformity of our 4 observers was 95.7%. Recognition of serration patterns was comparable in samples transported in saline and in Michel's medium and with section thicknesses of 4, 6, and 8 μm.
Limitations include our small sample size and the availability of 20 samples that were compared retrospectively.
DIF serration pattern analysis is not restricted by variation in laboratory procedures, transport medium, or experience of observers. This learnable technique can be implemented as a routine diagnostic method as an extension of DIF microscopy for subtyping PD.
皮肤活检标本的直接免疫荧光（DIF）显微镜检查是天疱疮疾病（PDs）诊断的参考标准。锯齿状模式分析可单独使用 DIF 显微镜将获得性大疱性表皮松解症（EBA）与其他 PD 区分开来。然而，为了将该技术纳入常规诊断程序，需要解决实践中的差距。
我们旨在确定和优化 DIF 显微镜锯齿状模式分析的技术要求，并确定锯齿状模式分析的观察者间一致性。
我们比较了荷兰格罗宁根和德国吕贝克的实验室常规 DIF 显微镜的锯齿状模式分析，并由 4 名盲法观察者进行分析。来自 20 名 EBA 和其他 PD 患者的皮肤活检标本被交换和分析。评估了各种因素，包括切片厚度、运输介质和活检标本处理。
我们的 4 名观察者间的一致性为 95.7%。在盐水中和 Michel 培养基中运输的样本以及厚度为 4、6 和 8μm 的样本中，锯齿模式的识别具有可比性。
限制包括我们的样本量小以及可供比较的 20 个样本都是回顾性的。
DIF 锯齿状模式分析不受实验室程序、运输介质或观察者经验的变化限制。这项可学习的技术可以作为 DIF 显微镜的扩展，作为 PD 亚型的常规诊断方法实施。
