Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
Department of Dermatology, University of Michigan, Ann Arbor, MI, USA.
Oral Dis. 2020 Jan;26(1):81-88. doi: 10.1111/odi.13159. Epub 2019 Oct 31.
Oral autoimmune bullous disorders show clinical overlap with diseases such as lichen planus and others that may cause desquamative gingivitis. As direct immunofluorescence is expensive, we sought to determine if routine histology alone would be sufficient to distinguish between oral autoimmune bullous disorders and mimics.
We searched the records for patients with a suspected oral autoimmune bullous disorder who underwent biopsies for concurrent routine histologic evaluation and direct immunofluorescence and who had at least one follow-up visit. Cases were separated into high and low suspicion subgroups based on clinical findings.
Within 148 cases, the sensitivity of routine histology alone was 0.810, with a negative predictive value of 0.889. However, the specificity was 0.989 with a positive predictive value of 0.979. Of the high suspicion cases, 57 (47.1%) were found to be consistent with an oral autoimmune bullous disorder, with a total of 11 histologic false negatives. 8 cases, all in the high suspicion subgroup, showed indeterminate direct immunofluorescence results. There were no histologic false negatives or inconclusive direct immunofluorescence results in the low suspicion subgroup.
In patients with a low clinical suspicion for an oral autoimmune bullous disorder, it is reasonable and more cost-effective to evaluate the lesion with routine histology alone.
口腔自身免疫性大疱性疾病与扁平苔藓等可能引起剥脱性龈炎的疾病存在临床重叠。由于直接免疫荧光检查费用昂贵，我们试图确定仅常规组织学是否足以区分口腔自身免疫性大疱性疾病及其类似疾病。
我们检索了接受活检以进行常规组织学评估和直接免疫荧光检查且至少有一次随访的疑似口腔自身免疫性大疱性疾病患者的记录。根据临床发现将病例分为高怀疑和低怀疑亚组。
在 148 例病例中，单独常规组织学的敏感性为 0.810，阴性预测值为 0.889。然而，特异性为 0.989，阳性预测值为 0.979。在高怀疑病例中，有 57 例（47.1%）与口腔自身免疫性大疱性疾病一致，总共有 11 例组织学假阴性。8 例均为高怀疑亚组，其直接免疫荧光结果不确定。在低怀疑亚组中没有组织学假阴性或不确定的直接免疫荧光结果。
对于临床怀疑度低的口腔自身免疫性大疱性疾病患者，单独评估病变的常规组织学检查是合理且更具成本效益的。
