Assessment of Cutaneous and Mucosal Direct Immunofluorescence Testing Practices in the US

Area of Science:

• Immunodermatology
• Diagnostic Laboratory Medicine
• Mucocutaneous Disease Diagnosis

Background:

• Direct immunofluorescence (DIF) testing is a long-standing diagnostic tool for inflammatory mucocutaneous conditions.
• Current DIF testing protocols lack rigorous validation and standardization.
• Key unresolved issues include the optimal use of DIF testing and panel selection based on clinical or histopathological findings.

Purpose of the Study:

• To establish consensus among US-based immunodermatology testing specialists on practical aspects of DIF testing.
• To evaluate expert opinion on the triage and truncation of DIF testing panels.

Main Methods:

• Modified Delphi method utilizing surveys and virtual discussion sessions.
• Two survey rounds conducted between January and April 2024.
• Inclusion of US immunodermatology laboratory directors and key opinion leaders.

Main Results:

• Consensus was achieved on 92.6% of statements regarding DIF testing practices.
• Strong consensus against tailoring DIF panels based on clinical indication.
• No consensus was reached on triaging DIF testing specimens by histopathology findings.

Conclusions:

• US immunodermatology specialists demonstrated agreement on numerous practical DIF testing aspects.
• Significant areas of ongoing debate were identified, particularly concerning histopathology-based triage.
• The study highlights the need for further research into standardized DIF testing protocols.