{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T20:59:41Z","timestamp":1767905981008,"version":"3.49.0"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,10,31]],"date-time":"2019-10-31T00:00:00Z","timestamp":1572480000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Oral Diseases"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Oral autoimmune bullous disorders show clinical overlap with diseases such as lichen planus and others that may cause desquamative gingivitis. As direct immunofluorescence is expensive, we sought to determine if routine histology alone would be sufficient to distinguish between oral autoimmune bullous disorders and mimics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched the records for patients with a suspected oral autoimmune bullous disorder who underwent biopsies for concurrent routine histologic evaluation and direct immunofluorescence and who had at least one follow\u2010up visit. Cases were separated into high and low suspicion subgroups based on clinical findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Within 148 cases, the sensitivity of routine histology alone was 0.810, with a negative predictive value of 0.889. However, the specificity was 0.989 with a positive predictive value of 0.979. Of the high suspicion cases, 57 (47.1%) were found to be consistent with an oral autoimmune bullous disorder, with a total of 11 histologic false negatives. 8 cases, all in the high suspicion subgroup, showed indeterminate direct immunofluorescence results. There were no histologic false negatives or inconclusive direct immunofluorescence results in the low suspicion subgroup.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with a low clinical suspicion for an oral autoimmune bullous disorder, it is reasonable and more cost\u2010effective to evaluate the lesion with routine histology alone.<\/jats:p><\/jats:sec>","DOI":"10.1111\/odi.13159","type":"journal-article","created":{"date-parts":[[2019,7,19]],"date-time":"2019-07-19T18:12:45Z","timestamp":1563559965000},"page":"81-88","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Direct immunofluorescence is of limited utility in patients with low clinical suspicion for an oral autoimmune bullous disorder"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2504-466X","authenticated-orcid":false,"given":"Scott C.","family":"Bresler","sequence":"first","affiliation":[{"name":"Department of Pathology University of Michigan Ann Arbor MI USA"},{"name":"Department of Dermatology University of Michigan Ann Arbor MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxanne","family":"Bavarian","sequence":"additional","affiliation":[{"name":"Division of Oral Medicine and Dentistry Brigham and Women's Hospital Boston MA USA"},{"name":"Harvard School of Dental Medicine Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott R.","family":"Granter","sequence":"additional","affiliation":[{"name":"Department of Pathology Brigham and Women's Hospital Boston MA USA"},{"name":"Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sook\u2010Bin","family":"Woo","sequence":"additional","affiliation":[{"name":"Division of Oral Medicine and Dentistry Brigham and Women's Hospital Boston MA USA"},{"name":"Harvard School of Dental Medicine Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,10,31]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/1735-3327.113328"},{"issue":"12","key":"e_1_2_7_3_1","first-page":"2788","article-title":"A cross\u2010sectional study of clinical, histopathological and direct immunofluorescence spectrum of vesiculobullous disorders","volume":"7","author":"Arundhathi S.","year":"2013","journal-title":"Journal of Clinical and Diagnostic Research"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.138.3.370"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oooo.2016.05.004"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2002.120452"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0091-6749(71)90025-X"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.14408"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2013.6739"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/cup.13347"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(92)90215-C"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(82)90461-3"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(82)90080-9"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1346-8138.1992.tb03743.x"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s003470050021"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oooo.2015.02.478"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.02.021"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oooo.2012.02.013"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2003.74.10.1545"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2230.1977.tb01550.x"},{"issue":"5","key":"e_1_2_7_21_1","first-page":"287","article-title":"Sensitivity of direct immunofluorescence in oral diseases. Study of 125 cases","volume":"13","author":"Sano S. 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