Serration pattern analysis for differentiating epidermolysis bullosa acquisita from other pemphigoid diseases
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...
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| Veröffentlicht in: | Journal of the American Academy of Dermatology 2018-04, Vol.78 (4), p.754-759.e6 |
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| creator | Meijer, Joost M. Atefi, Ingeborg Diercks, Gilles F.H. Vorobyev, Artem Zuiderveen, Janny Meijer, Hillegonda J. Pas, Hendri H. Zillikens, Detlef Schmidt, Enno Jonkman, Marcel F. |
| description | 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.
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| doi_str_mv | 10.1016/j.jaad.2017.11.029 |
| format | Article |
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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.
[Display omitted]</description><identifier>ISSN: 0190-9622</identifier><identifier>EISSN: 1097-6787</identifier><identifier>DOI: 10.1016/j.jaad.2017.11.029</identifier><identifier>PMID: 29154993</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>autoimmune bullous disease ; basement membrane ; dermatopathology ; diagnostic technique ; direct immunofluorescence microscopy ; epidermolysis bullosa acquisita ; pemphigoid</subject><ispartof>Journal of the American Academy of Dermatology, 2018-04, Vol.78 (4), p.754-759.e6</ispartof><rights>2017 American Academy of Dermatology, Inc.</rights><rights>Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-66b44acd8d8e4c096e7849a8b7b45547c9ab50a22fe7c5a0f5e3390f2634b5c33</citedby><cites>FETCH-LOGICAL-c466t-66b44acd8d8e4c096e7849a8b7b45547c9ab50a22fe7c5a0f5e3390f2634b5c33</cites><orcidid>0000-0002-8471-9340</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0190962217326956$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29154993$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meijer, Joost M.</creatorcontrib><creatorcontrib>Atefi, Ingeborg</creatorcontrib><creatorcontrib>Diercks, Gilles F.H.</creatorcontrib><creatorcontrib>Vorobyev, Artem</creatorcontrib><creatorcontrib>Zuiderveen, Janny</creatorcontrib><creatorcontrib>Meijer, Hillegonda J.</creatorcontrib><creatorcontrib>Pas, Hendri H.</creatorcontrib><creatorcontrib>Zillikens, Detlef</creatorcontrib><creatorcontrib>Schmidt, Enno</creatorcontrib><creatorcontrib>Jonkman, Marcel F.</creatorcontrib><title>Serration pattern analysis for differentiating epidermolysis bullosa acquisita from other pemphigoid diseases</title><title>Journal of the American Academy of Dermatology</title><addtitle>J Am Acad Dermatol</addtitle><description>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.
[Display omitted]</description><subject>autoimmune bullous disease</subject><subject>basement membrane</subject><subject>dermatopathology</subject><subject>diagnostic technique</subject><subject>direct immunofluorescence microscopy</subject><subject>epidermolysis bullosa acquisita</subject><subject>pemphigoid</subject><issn>0190-9622</issn><issn>1097-6787</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kDFv1TAURi0Eoq-FP8CAPLIk2I5jxxILqgpUqsQAzNaNfd36KYlT20HqvydPrzAy3eV8R7qHkHectZxx9fHYHgF8KxjXLectE-YFOXBmdKP0oF-SA-OGNUYJcUEuSzkyxozs9GtyIQzvpTHdgcw_MGeoMS10hVoxLxQWmJ5KLDSkTH0MATMuNe7Qck9xjR7znM7EuE1TKkDBPW6xxAo05DTTVB8w0xXn9SHep-h3S0EoWN6QVwGmgm-f7xX59eXm5_W35u7719vrz3eNk0rVRqlRSnB-8ANKx4xCPUgDw6hH2fdSOwNjz0CIgNr1wEKPXWdYEKqTY--67op8OHvXnB43LNXOsTicJlgwbcVyo5Tsue7kjooz6nIqJWOwa44z5CfLmT1ltkd7ymxPmS3nds-8j94_-7dxRv9v8rfrDnw6A7h_-TtitsVFXBz6mNFV61P8n_8PTNCRPg</recordid><startdate>20180401</startdate><enddate>20180401</enddate><creator>Meijer, Joost M.</creator><creator>Atefi, Ingeborg</creator><creator>Diercks, Gilles F.H.</creator><creator>Vorobyev, Artem</creator><creator>Zuiderveen, Janny</creator><creator>Meijer, Hillegonda J.</creator><creator>Pas, Hendri H.</creator><creator>Zillikens, Detlef</creator><creator>Schmidt, Enno</creator><creator>Jonkman, Marcel F.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8471-9340</orcidid></search><sort><creationdate>20180401</creationdate><title>Serration pattern analysis for differentiating epidermolysis bullosa acquisita from other pemphigoid diseases</title><author>Meijer, Joost M. ; Atefi, Ingeborg ; Diercks, Gilles F.H. ; Vorobyev, Artem ; Zuiderveen, Janny ; Meijer, Hillegonda J. ; Pas, Hendri H. ; Zillikens, Detlef ; Schmidt, Enno ; Jonkman, Marcel F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-66b44acd8d8e4c096e7849a8b7b45547c9ab50a22fe7c5a0f5e3390f2634b5c33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>autoimmune bullous disease</topic><topic>basement membrane</topic><topic>dermatopathology</topic><topic>diagnostic technique</topic><topic>direct immunofluorescence microscopy</topic><topic>epidermolysis bullosa acquisita</topic><topic>pemphigoid</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Meijer, Joost M.</creatorcontrib><creatorcontrib>Atefi, Ingeborg</creatorcontrib><creatorcontrib>Diercks, Gilles F.H.</creatorcontrib><creatorcontrib>Vorobyev, Artem</creatorcontrib><creatorcontrib>Zuiderveen, Janny</creatorcontrib><creatorcontrib>Meijer, Hillegonda J.</creatorcontrib><creatorcontrib>Pas, Hendri H.</creatorcontrib><creatorcontrib>Zillikens, Detlef</creatorcontrib><creatorcontrib>Schmidt, Enno</creatorcontrib><creatorcontrib>Jonkman, Marcel F.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Academy of Dermatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Meijer, Joost M.</au><au>Atefi, Ingeborg</au><au>Diercks, Gilles F.H.</au><au>Vorobyev, Artem</au><au>Zuiderveen, Janny</au><au>Meijer, Hillegonda J.</au><au>Pas, Hendri H.</au><au>Zillikens, Detlef</au><au>Schmidt, Enno</au><au>Jonkman, Marcel F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serration pattern analysis for differentiating epidermolysis bullosa acquisita from other pemphigoid diseases</atitle><jtitle>Journal of the American Academy of Dermatology</jtitle><addtitle>J Am Acad Dermatol</addtitle><date>2018-04-01</date><risdate>2018</risdate><volume>78</volume><issue>4</issue><spage>754</spage><epage>759.e6</epage><pages>754-759.e6</pages><issn>0190-9622</issn><eissn>1097-6787</eissn><abstract>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.
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| subjects | autoimmune bullous disease basement membrane dermatopathology diagnostic technique direct immunofluorescence microscopy epidermolysis bullosa acquisita pemphigoid |
| title | Serration pattern analysis for differentiating epidermolysis bullosa acquisita from other pemphigoid diseases |
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