Journal of cutaneous pathology · 2023
The modified HoVert (mHoVert) method improves diagnostic certainty compared to the St John's protocol for alopecia biopsy specimens: A retrospective single center study.
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Adams Laura, Amphlett Alexander, Gardette Emma, Deroide Florence, Jones Jennifer
Аннотация
BACKGROUND: Access to vertical and transverse sections of a punch biopsy specimen improves the diagnosis of alopecia. Both two biopsy specimen and single-punch biopsy specimen techniques to visualize both transverse and vertical sections have been described. Their comparative diagnostic certainty is not known. We aimed to assess the diagnostic certainty of a modified HoVert (mHoVert) method, without direct immunofluorescence (DIF), compared to the St John's protocol, a two-biopsy technique with DIF.
METHODS: Fifty-seven cases of alopecia processed using the St John's protocol and 60 cases of alopecia processed using mHoVert were reviewed. Diagnoses made were rated as certain/probable, possible, or uncertain, depending on the language in the histopathology report. Cases processed by the St John's protocol had final diagnosis and DIF result recorded.
RESULTS: In the mHoVert group, significantly more diagnoses were certain/probable (66%, 95% confidence interval [CI]: 57%-75%), compared to 46% (95% CI: 36%-56%) of diagnoses in the St John's protocol group (p = 0.005). DIF result did not affect the final diagnosis in any of the 57 cases reviewed.
CONCLUSIONS: DIF is not required in the diagnosis of most cases of alopecia. The mHoVert method provides more certain/probable diagnoses than the St John's protocol and can reduce cost and patient morbidity.
METHODS: Fifty-seven cases of alopecia processed using the St John's protocol and 60 cases of alopecia processed using mHoVert were reviewed. Diagnoses made were rated as certain/probable, possible, or uncertain, depending on the language in the histopathology report. Cases processed by the St John's protocol had final diagnosis and DIF result recorded.
RESULTS: In the mHoVert group, significantly more diagnoses were certain/probable (66%, 95% confidence interval [CI]: 57%-75%), compared to 46% (95% CI: 36%-56%) of diagnoses in the St John's protocol group (p = 0.005). DIF result did not affect the final diagnosis in any of the 57 cases reviewed.
CONCLUSIONS: DIF is not required in the diagnosis of most cases of alopecia. The mHoVert method provides more certain/probable diagnoses than the St John's protocol and can reduce cost and patient morbidity.