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Inter-Rater Reliability of the Biochip Indirect Immunofluorescence Dermatology Mosaic in Bullous Pemphigoid and Pemphigus Patients Publisher Pubmed



Yang A1, 2 ; Xuan RR1 ; Melbourne W2 ; Hashimoto T3 ; Uzun S4 ; Daneshpazhooh M5 ; Yamagami J6 ; Di Zenzo G7 ; Mahmoudi H5 ; Patsatsi A9 ; Drenovska K10 ; Vassileva S10 ; Murrell DF1, 2
Authors
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Authors Affiliations
  1. 1. University of New South Wales, Kogarah, NSW, Australia
  2. 2. Department of Dermatology, St George Hospital, Sydney, NSW, Australia
  3. 3. Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
  4. 4. Department of Dermatology, Akdeniz University School of Medicine, Antalya, Turkey
  5. 5. Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
  7. 7. Molecular and Cell Biology laboratory, IDI-IRCCS, Rome, Italy
  8. 8. Hospital Clinic and Barcelona University Medical School, Barcelona, Spain
  9. 9. 2nd Dermatology Department, Aristotle University School of Medicine, Thessaloniki, Greece
  10. 10. Department of Dermatology and Venereology, Sofia University of Medicine, Sofia, Bulgaria

Source: Journal of the European Academy of Dermatology and Venereology Published:2019


Abstract

Background: The BIOCHIP (Dermatology Mosaic 7; EUROIMMUN, Lubeck, Germany) is a novel multiplex indirect immunofluorescence (IIF) technique used in the serological diagnosis of bullous pemphigoid (BP) and pemphigus. Objective: To validate the accuracy and inter-rater reliability (IRR) of the BIOCHIP in the diagnosis of BP, pemphigus foliaceus (PF) and pemphigus vulgaris (PV). Methods: Sera from patients with BP (n = 38), PF (n = 8), PV (n = 23), control patients (n = 64) and healthy control volunteers (n = 39) were tested. Sera were collected and analysed during the course of the disease at 1–5 different time points. The BIOCHIP was performed for all patients, digital images were captured of each incubated field, and the images were shared with 10 dermatologists experienced in reading IF from around the world to report. There were 312 BIOCHIP slides consisting of 1872 photos in total. All patients were de-identified. Fleiss Kappa was used to estimate the IRR. Results: Fleiss Kappa was computed for each category (Oesophagus, Oesophagus immunofluorescence pattern, Salt-Split Skin (SSS), SSS immunofluorescence location, BP180, BP230, Dsg 1 and Ds3). The inter-rater agreement between the 10 raters varied between fair and moderate for all categories. Those that demonstrated fair concordance included monkey oesophagus (k = 0.257, P < 0.0001), oesophagus pattern (k = 0.357, P < 0.0001), Dsg1 (k = 0.390, P < 0.0001) and BP230 (k = 0.281, P < 0.0001). Moderate agreement was demonstrated for SSS (k = 0.416, P < 0.0001), SSS immunofluorescence location (k = 0.505, P < 0.0001), Dsg3 (k = 0.437, P < 0.0001) and BP180 (k = 0.559, P < 0.0001). Conclusion: The BIOCHIP mosaic-based immunofluorescence test is a simple, time and effort saving test that can aid in the diagnosis and screening of BP, PV and PF. However, the level of agreement was relatively low. The authors found the most common causes to be variable levels of training, indicating the presence of a learning curve in the interpretation of the results and ambiguous staining patterns leading to incongruent results. © 2019 European Academy of Dermatology and Venereology