The n- vs. u-serration is a learnable criterion to differentiate pemphigoid from epidermolysis bullosa acquisita in direct immunofluorescence serration pattern analysis
Summary Background 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. Objectives To test the learnability of D...
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| Veröffentlicht in: | British journal of dermatology (1951) 2013-07, Vol.169 (1), p.100-105 |
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| container_title | British journal of dermatology (1951) |
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| creator | Terra, J.B. Meijer, J.M. Jonkman, M.F. Diercks, G.F.H. |
| description | Summary
Background
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.
Objectives
To test the learnability of DIF serrated‐pattern recognition in groups with various a priori levels of competence.
Methods
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.
Results
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 |
| doi_str_mv | 10.1111/bjd.12308 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1430851826</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1399264171</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4928-4b24e7890b4dc97b0ad278dcddb32bae034248eaa0d788970446aca3c72c13ae3</originalsourceid><addsrcrecordid>eNqFkc9u1DAQxiMEokvhwAsgX5DKIVv_2zg5sgUW0AouBY7WxJ5QFydO7QTYN-Ixcbvb9oSYyxzmN983mq8onjO6ZLlO20u7ZFzQ-kGxYKJalZwJ8bBYUEpVSZtKHBVPUrqklAm6oo-LIy5k3fCKL4o_5xdIhpL8TEsylwljhMmFgbhEgHiEOEDrkZjoJozXgykQ67oOIw6TgwnJiP144b4HZ0kXQ09wdBZjH_wuZZF29j4kIGCuZpfcBMQNWSCimYjr-3kInZ9DxGRwMEjuDxhhyo4DgQFulJ4WjzrwCZ8d-nHx5d3b87P35fbz5sPZ621pZMPrUrZcoqob2kprGtVSsFzV1ljbCt4CUiG5rBGAWlXXjaJSVmBAGMUNE4DiuDjZ644xXM2YJt27fJz3MGCYk2Yy_3nFal79HxVNfrJkimX01R41MaQUsdNjdD3EnWZUX2eoc4b6JsPMvjjIzm2P9o68DS0DLw8AJAO-izAYl-45VeWUa5m50z33y3nc_dtRrz--ubUu9xsuTfj7bgPiD10poVb626eNpnLd0O1mrb-Kv-itxZo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1399264171</pqid></control><display><type>article</type><title>The n- vs. u-serration is a learnable criterion to differentiate pemphigoid from epidermolysis bullosa acquisita in direct immunofluorescence serration pattern analysis</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Terra, J.B. ; Meijer, J.M. ; Jonkman, M.F. ; Diercks, G.F.H.</creator><creatorcontrib>Terra, J.B. ; Meijer, J.M. ; Jonkman, M.F. ; Diercks, G.F.H.</creatorcontrib><description>Summary
Background
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.
Objectives
To test the learnability of DIF serrated‐pattern recognition in groups with various a priori levels of competence.
Methods
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.
Results
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.
Conclusions
Serration pattern analysis by DIF can be learned irrespective of background of expertise.
What's already known about this topic?
Serration pattern analysis by routine direct immunofluorescence (DIF) shows linear n‐serration or linear u‐serration immunodepositions along the epidermal basement membrane zone.
What does this study add?
We are the first to describe that the recognition of n‐ and u‐serrated DIF patterns is easy to learn with instruction. Our online test can be used worldwide to increase the experience with DIF serration pattern analysis, and the standard use will ensure more accurate diagnosis of patients with a subtype of pemphigoid so that treatment can be optimized.</description><identifier>ISSN: 0007-0963</identifier><identifier>EISSN: 1365-2133</identifier><identifier>DOI: 10.1111/bjd.12308</identifier><identifier>PMID: 23489262</identifier><identifier>CODEN: BJDEAZ</identifier><language>eng</language><publisher>Oxford: Blackwell Publishing Ltd</publisher><subject>Adult ; Biological and medical sciences ; Bullous diseases of the skin ; Clinical Competence - standards ; Dermatology ; Dermatology - education ; Dermatology - standards ; Diagnosis, Differential ; Epidermolysis Bullosa Acquisita - pathology ; Female ; Fluorescent Antibody Technique, Direct - standards ; Humans ; Internship and Residency - standards ; Medical sciences ; Netherlands ; Pemphigoid, Bullous - pathology ; Teaching</subject><ispartof>British journal of dermatology (1951), 2013-07, Vol.169 (1), p.100-105</ispartof><rights>2013 The Authors BJD © 2013 British Association of Dermatologists</rights><rights>2014 INIST-CNRS</rights><rights>2013 The Authors BJD © 2013 British Association of Dermatologists.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4928-4b24e7890b4dc97b0ad278dcddb32bae034248eaa0d788970446aca3c72c13ae3</citedby><cites>FETCH-LOGICAL-c4928-4b24e7890b4dc97b0ad278dcddb32bae034248eaa0d788970446aca3c72c13ae3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fbjd.12308$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fbjd.12308$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27605084$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23489262$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Terra, J.B.</creatorcontrib><creatorcontrib>Meijer, J.M.</creatorcontrib><creatorcontrib>Jonkman, M.F.</creatorcontrib><creatorcontrib>Diercks, G.F.H.</creatorcontrib><title>The n- vs. u-serration is a learnable criterion to differentiate pemphigoid from epidermolysis bullosa acquisita in direct immunofluorescence serration pattern analysis</title><title>British journal of dermatology (1951)</title><addtitle>Br J Dermatol</addtitle><description>Summary
Background
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.
Objectives
To test the learnability of DIF serrated‐pattern recognition in groups with various a priori levels of competence.
Methods
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.
Results
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.
Conclusions
Serration pattern analysis by DIF can be learned irrespective of background of expertise.
What's already known about this topic?
Serration pattern analysis by routine direct immunofluorescence (DIF) shows linear n‐serration or linear u‐serration immunodepositions along the epidermal basement membrane zone.
What does this study add?
We are the first to describe that the recognition of n‐ and u‐serrated DIF patterns is easy to learn with instruction. Our online test can be used worldwide to increase the experience with DIF serration pattern analysis, and the standard use will ensure more accurate diagnosis of patients with a subtype of pemphigoid so that treatment can be optimized.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Bullous diseases of the skin</subject><subject>Clinical Competence - standards</subject><subject>Dermatology</subject><subject>Dermatology - education</subject><subject>Dermatology - standards</subject><subject>Diagnosis, Differential</subject><subject>Epidermolysis Bullosa Acquisita - pathology</subject><subject>Female</subject><subject>Fluorescent Antibody Technique, Direct - standards</subject><subject>Humans</subject><subject>Internship and Residency - standards</subject><subject>Medical sciences</subject><subject>Netherlands</subject><subject>Pemphigoid, Bullous - pathology</subject><subject>Teaching</subject><issn>0007-0963</issn><issn>1365-2133</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc9u1DAQxiMEokvhwAsgX5DKIVv_2zg5sgUW0AouBY7WxJ5QFydO7QTYN-Ixcbvb9oSYyxzmN983mq8onjO6ZLlO20u7ZFzQ-kGxYKJalZwJ8bBYUEpVSZtKHBVPUrqklAm6oo-LIy5k3fCKL4o_5xdIhpL8TEsylwljhMmFgbhEgHiEOEDrkZjoJozXgykQ67oOIw6TgwnJiP144b4HZ0kXQ09wdBZjH_wuZZF29j4kIGCuZpfcBMQNWSCimYjr-3kInZ9DxGRwMEjuDxhhyo4DgQFulJ4WjzrwCZ8d-nHx5d3b87P35fbz5sPZ621pZMPrUrZcoqob2kprGtVSsFzV1ljbCt4CUiG5rBGAWlXXjaJSVmBAGMUNE4DiuDjZ644xXM2YJt27fJz3MGCYk2Yy_3nFal79HxVNfrJkimX01R41MaQUsdNjdD3EnWZUX2eoc4b6JsPMvjjIzm2P9o68DS0DLw8AJAO-izAYl-45VeWUa5m50z33y3nc_dtRrz--ubUu9xsuTfj7bgPiD10poVb626eNpnLd0O1mrb-Kv-itxZo</recordid><startdate>201307</startdate><enddate>201307</enddate><creator>Terra, J.B.</creator><creator>Meijer, J.M.</creator><creator>Jonkman, M.F.</creator><creator>Diercks, G.F.H.</creator><general>Blackwell Publishing Ltd</general><general>Wiley-Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7T5</scope><scope>H94</scope></search><sort><creationdate>201307</creationdate><title>The n- vs. u-serration is a learnable criterion to differentiate pemphigoid from epidermolysis bullosa acquisita in direct immunofluorescence serration pattern analysis</title><author>Terra, J.B. ; Meijer, J.M. ; Jonkman, M.F. ; Diercks, G.F.H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4928-4b24e7890b4dc97b0ad278dcddb32bae034248eaa0d788970446aca3c72c13ae3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Bullous diseases of the skin</topic><topic>Clinical Competence - standards</topic><topic>Dermatology</topic><topic>Dermatology - education</topic><topic>Dermatology - standards</topic><topic>Diagnosis, Differential</topic><topic>Epidermolysis Bullosa Acquisita - pathology</topic><topic>Female</topic><topic>Fluorescent Antibody Technique, Direct - standards</topic><topic>Humans</topic><topic>Internship and Residency - standards</topic><topic>Medical sciences</topic><topic>Netherlands</topic><topic>Pemphigoid, Bullous - pathology</topic><topic>Teaching</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Terra, J.B.</creatorcontrib><creatorcontrib>Meijer, J.M.</creatorcontrib><creatorcontrib>Jonkman, M.F.</creatorcontrib><creatorcontrib>Diercks, G.F.H.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>British journal of dermatology (1951)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Terra, J.B.</au><au>Meijer, J.M.</au><au>Jonkman, M.F.</au><au>Diercks, G.F.H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The n- vs. u-serration is a learnable criterion to differentiate pemphigoid from epidermolysis bullosa acquisita in direct immunofluorescence serration pattern analysis</atitle><jtitle>British journal of dermatology (1951)</jtitle><addtitle>Br J Dermatol</addtitle><date>2013-07</date><risdate>2013</risdate><volume>169</volume><issue>1</issue><spage>100</spage><epage>105</epage><pages>100-105</pages><issn>0007-0963</issn><eissn>1365-2133</eissn><coden>BJDEAZ</coden><abstract>Summary
Background
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.
Objectives
To test the learnability of DIF serrated‐pattern recognition in groups with various a priori levels of competence.
Methods
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.
Results
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.
Conclusions
Serration pattern analysis by DIF can be learned irrespective of background of expertise.
What's already known about this topic?
Serration pattern analysis by routine direct immunofluorescence (DIF) shows linear n‐serration or linear u‐serration immunodepositions along the epidermal basement membrane zone.
What does this study add?
We are the first to describe that the recognition of n‐ and u‐serrated DIF patterns is easy to learn with instruction. Our online test can be used worldwide to increase the experience with DIF serration pattern analysis, and the standard use will ensure more accurate diagnosis of patients with a subtype of pemphigoid so that treatment can be optimized.</abstract><cop>Oxford</cop><pub>Blackwell Publishing Ltd</pub><pmid>23489262</pmid><doi>10.1111/bjd.12308</doi><tpages>6</tpages></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Biological and medical sciences Bullous diseases of the skin Clinical Competence - standards Dermatology Dermatology - education Dermatology - standards Diagnosis, Differential Epidermolysis Bullosa Acquisita - pathology Female Fluorescent Antibody Technique, Direct - standards Humans Internship and Residency - standards Medical sciences Netherlands Pemphigoid, Bullous - pathology Teaching |
| title | The n- vs. u-serration is a learnable criterion to differentiate pemphigoid from epidermolysis bullosa acquisita in direct immunofluorescence serration pattern analysis |
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