Meijer, J. (Joost) (2013) n-serrated versus u-serrated immunofluorescentie depositiepatronen in subepidermale auto-immuun blaarziekten. thesis, Medicine.
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Abstract
Introduction: Subepidermal autoimmune blistering diseases (sAIBD) is a rare, heterogeneous group of skin diseases characterized by autoantibodies against adhesion molecules of the epidermal basement membrane zone (BMZ). Differentiation in subtypes of sAIBD is impossible by clinical presentation, but is needed because of different treatment strategies, disease prognosis and an increased relative risk of malignancy in one subtype. Many laboratory techniques are needed to establish an accurate diagnosis of the subtype of sAIBD. Serration pattern analysis allows to differentiate epidermolysis bullosa acquisita and bullous SLE from other forms of sAIBD by direct immunofluorescence (DIF) alone. Its use is however limited due to lack of training in serrationpattern recognition. Aim of this study is to test the recognition of n-serrated and u-serrated patterns in DIF before and after instruction. Methods: 75 participants completed the online nversusu-test, including three groups: UMCG dermatology staff, international experts in sAIBD and Dutch dermatologists and pathologists. The test contains 26 DIF images of the epidermal BMZ, IgG stained and with a magnification of 40x and 63x. 13 DIF images were presented before a short instruction video about n- and u-serrated patterns in DIF and another 13 DIF images after the instruction. There were three options to choose from: n-serrated, u-serrated or undetermined. Results: Recognition of n-serrated and u-serrated patterns in DIF was significantly higher after instruction (p<0,001), with a mean of 66% correct answers before instruction and 79% after instruction. No significant difference was found between the three groups. The u-serrated DIF pattern was recognized the most. Conclusion. Recognition of n-serrated and u-serrated patterns in DIF in subepidermal autoimmune blistering diseases improves after instruction. Serration pattern analysis in DIF is teachable and allows to differentiate in sAIBD by DIF alone. This shows the relevance of serration pattern analysis in DIF in the diagnostic algorithm of sAIBD.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Jonkman, Prof.dr. M.F. and Diercks, Dr. G.F.H. and Terra, Drs. J.B. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1332 |
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