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Updated: Jan 30, 2026

Technique of Conjunctival Biopsy and Direct Immunofluorescence for Diagnosing Mucous Membrane Pemphigoid
Published on: June 17, 2025
Diagnostic value of direct immunofluorescence in oral mucous membrane pemphigoid: a retrospective study
Hongjie Jiang1, Pan Wei2, Zhixiu Xu3
1Department of Oral Pathology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Hospital of Stomatology, Peking University, Beijing, China; The Affiliated Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Municipal Health Commission Key Laboratory of Oral Biomedical Engineering, Chongqing, China.
Background:
Mucous membrane pemphigoid (MMP) is an autoimmune blistering disease with heterogeneous clinical manifestations that is hard to diagnose. Direct immunofluorescence (DIF) is critical, but its role in multimodal frameworks is unclear.
Objective:
To assess DIF's diagnostic performance in MMP and explore factors affecting its positivity patterns in multimodal workflows.
Methods:
We retrospectively analyzed 79 suspected MMP patients, categorizing them into confirmed and non-confirmed groups based on clinical, histopathological, and serological criteria. DIF of perilesional mucosal biopsies showed linear deposits of IgG, IgA, IgM, C3, and fibrinogen along the basement membrane zone (BMZ). Diagnostic efficacy was assessed via ROC curve analysis.
Results:
55 cases were confirmed. Histopathology demonstrated subepithelial blisters in 51, with 100% specificity, 92.73% sensitivity (AUC = 0.964, p < 0.05). DIF identified 47 cases, with C3 (63.64%) and IgG (60.00%) most common, showing 85.45% sensitivity, 100% specificity, and 97.87% concordance with histopathology. Disease duration independently predicted positive IgM (p = 0.023).
Study Limitations:
This study is a single-center retrospective study with a limited sample size, which has certain limitations.
Conclusion:
DIF, 100% specific, aids histopathology in MMP diagnosis, especially with C3/IgG linear BMZ deposition. Notably, IgM positivity correlates with prolonged disease duration, suggesting DIF efficiency may link to disease stage.
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