Diagnostic value of immunohistochemistry on formalin-fixed, paraffin-embedded skin biopsy specimens for bullous pemphigoid

Abstract

Funding  None Conflict of interest  None declared What's already known about this topic? Direct immunofluorescence microscopy (DIF) studies represent the gold standard for the diagnosis of bullous pemphigoid (BP). Recent studies have reported that immunohistochemistry techniques using formalin-fixed, paraffinembedded skin biopsy specimens are able to detect tissue-bound immunoreactants in BP with high sensitivity and thus constitute an alternative and practical diagnostic tool. What does this study add? Immunohistochemical analyses are not sensitive enough to recommend their use for the diagnosis of BP, since less than 50% of 51 consecutive paraffin-embedded skin biopsy specimens obtained from patients with newly diagnosed BP were positive. If DIF cannot be performed, immunohistochemistry represents a useful diagnostic tool only in presence of histologically subepidermal blistering and/or with positive immunoserological tests , which are associated with a better sensitivity. Manuscript words 2845, tables 2 and figures 2, Abstract 248Abstract Background: Direct immunofluorescence microscopy (DIF) studies constitute the gold standard for

Immunohistochemical diagnosis of mucous membrane pemphigoid

“…The sensitivity of IHC for C3d/C4d previously reported for BP varied widely from 37% to 100%, while the numbers for pemphigus were more consistent at 77%‐82% . This variability may be due to different patient selection criteria or to particular laboratory protocols used in these investigations.…”

“…In recent years, several studies have examined the application of IHC on FFPE biopsies for confirming the diagnosis of various autoimmune blistering dermatoses, most notably BP and pemphigus . While 2 older reports have described the use of IHC on cryosections of conjunctival biopsies from patients with ocular MMP, no data on the use of IHC on FFPE material from patients with MMP have been published to date.…”

“…Performance of DIF studies depends on the availability of a non‐fixed tissue biopsy and of special equipment needed to produce cryosections and to read slides stained with fluorescein‐tagged antibodies. To overcome this problem, multiple reports have examined the utility of immunohistochemistry (IHC) for detecting immunoreactants in formalin‐fixed, paraffin‐embedded (FFPE) tissue samples from patients with other autoimmune bullous diseases such as bullous pemphigoid (BP), pemphigoid gestationis and pemphigus . In this study, we examine the value of this technique for diagnosing MMP.…”

Diagnosis of autoimmune bullous diseases

“…Various studies have evaluated the visualization of immunoglobulins and C3d/C4d in paraffin‐embedded lesional biopsies. The results to date have shown significantly lower sensitivity and specificity than for direct IF microscopy of perilesional biopsies .…”

Diagnostik blasenbildender Autoimmundermatosen

“…In verschiedenen Studien wurde die Visualisierung von Immunglobulinen und C3d/C4d in läsionalen, in Paraffin eingebetteten Biopsien untersucht. Die bisherigen Resultate ergaben eine deutlich geringere Sensitivität und Spezifität als die direkte IF‐Mikroskopie periläsionaler Biopsien .…”