Carey B, Joshi S, Abdelghani A, Mee J, Andiappan M, Setterfield J
Oral Medicine, Dental Institute, Guy's and St Thomas' NHS Foundation Trust, London, U.K.
Oral Medicine, College of Dentistry, Taibah University, Al Madinah, Saudi Arabia.
Br J Dermatol. 2020 Mar;182(3):747-753. doi: 10.1111/bjd.18032. Epub 2019 Jul 15.
Accepted 'standard practice' for the diagnosis of immunobullous disease is a perilesional sample for direct immunofluorescence (DIF).
To compare diagnostic outcomes of a normal buccal punch biopsy (NBPB) with a perilesional biopsy (PLB) for mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV).
A retrospective analysis of 251 DIF-positive patients with MMP and 77 DIF-positive patients with PV was undertaken. Parameters analysed included the intraoral sites of involvement and histopathological, DIF and indirect immunofluorescence (IIF) findings.
For MMP, PLB was positive in 134 of 143 (93·7%) samples, compared with 129 of 144 (89·6%) by NBPB. The diagnostic sensitivities for PLB (81%, 39 of 48) and NBPB (77%, 37 of 48) among 48 patients who underwent both techniques were not significantly different (P = 0·62). In gingival-only MMP, PLB was positive in 63 of 69 (91%) and NBPB was positive in 63 of 75 (84%). For multisite MMP, PLB was positive in 71 of 74 (96%) and NBPB was positive in 66 of 69 (96%). In gingival-only MMP, biopsies from reflected alveolar mucosa in 17 consecutive patients were positive in 17 of 17 cases (100%). For PV, PLB was positive in 42 of 43 (98%), compared with 42 of 42 (100%) by NBPB. Histopathology was diagnostic in 93 of 134 (69·4%) cases of MMP and 38 of 41 (93%) cases of PV. IIF was positive in 126 of 197 (64·0%) MMP and 68 of 74 (92%) PV patient sera.
In the largest series of combined oral DIF results in patients with MMP and PV, we have shown that NBPB is equivalent to PLB for the diagnosis of PV and multisite MMP, and is more sensitive than both histology and IIF. What's already known about this topic? The variation in sensitivity of oral biopsy sites for direct immunofluorescence (DIF) in the diagnosis of oral MMP and PV has not been studied in detail in large series of patients. Biopsy can be challenging due to difficult access and fragility of the oral mucosa. The diagnostic biopsy technique is therefore critical. What does this study add? We have shown that a normal buccal punch biopsy (NBPB) from uninvolved oral mucosa is as sensitive as a perilesional biopsy (PLB) for diagnosis of oral PV, and superior to serology and histology. For multisite MMP, NBPB is equivalent to PLB and is more sensitive than serology and histology. The oral punch biopsy technique on uninvolved buccal mucosa tissue is a simple and safe practical method for diagnosing oral PV and MMP.
免疫性大疱性疾病诊断的公认“标准做法”是取病损周围样本进行直接免疫荧光检查（DIF）。
比较正常颊部打孔活检（NBPB）与病损周围活检（PLB）对黏膜类天疱疮（MMP）和寻常型天疱疮（PV）的诊断结果。
对251例DIF阳性的MMP患者和77例DIF阳性的PV患者进行回顾性分析。分析的参数包括口腔受累部位以及组织病理学、DIF和间接免疫荧光（IIF）检查结果。
对于MMP，143份样本中的134份（93.7%）PLB呈阳性，而144份样本中的129份（89.6%）NBPB呈阳性。在48例同时接受两种检查方法的患者中，PLB（81%，48例中的39例）和NBPB（77%，48例中的37例）的诊断敏感性无显著差异（P = 0.62）。仅累及牙龈的MMP中，69份样本中的63份（91%）PLB呈阳性，75份样本中的63份（84%）NBPB呈阳性。对于多部位MMP，74份样本中的71份（96%）PLB呈阳性，69份样本中的66份（96%）NBPB呈阳性。在仅累及牙龈的MMP中，连续17例患者的翻瓣牙槽黏膜活检样本全部17份（100%）呈阳性。对于PV，43份样本中的42份（98%）PLB呈阳性，而42份样本中的42份（100%）NBPB呈阳性。组织病理学诊断出134例MMP病例中的93例（69.4%）和41例PV病例中的38例（93%）。IIF在197例MMP患者血清中的126例（64.0%）和74例PV患者血清中的68例（92%）呈阳性。
在关于MMP和PV患者口腔DIF联合结果的最大规模系列研究中，我们发现NBPB在诊断PV和多部位MMP方面与PLB等效，且比组织学和IIF更敏感。关于该主题已了解哪些内容？在大量患者中，尚未对口腔活检部位在诊断口腔MMP和PV时直接免疫荧光（DIF）敏感性的差异进行详细研究。由于口腔黏膜难以取材且质地脆弱，活检可能具有挑战性。因此，诊断性活检技术至关重要。本研究有何新发现？我们发现从未受累口腔黏膜进行的正常颊部打孔活检（NBPB）在诊断口腔PV方面与病损周围活检（PLB）一样敏感，且优于血清学和组织学。对于多部位MMP，NBPB与PLB等效，且比血清学和组织学更敏感。对未受累颊黏膜组织进行口腔打孔活检技术是诊断口腔PV和MMP的一种简单、安全且实用的方法。
