Wieland, Carilyn N.

AbstractBackgroundThe pemphigus group is characterized by the presence of circulating immunoglobulins against desmosomes. IgG/IgA pemphigus is defined by the presence of IgG and IgA cell surface deposits upon direct immunofluorescence (DIF) and/or circulating IgG and IgA autoantibodies upon indirect immunofluorescence. Previous reports of patients with IgG/IgA pemphigus are sparse. Whether IgG/IgA pemphigus is best classified as a subtype of IgG (classic) pemphigus or IgA pemphigus, or as a distinct entity, has yet to be determined.ObjectivesWe compared the features of patients with IgG/IgA pemphigus to those of IgG pemphigus and IgA pemphigus.MethodsRetrospective clinicopathologic study of patients with IgG, IgG/IgA, and IgA pemphigus evaluated at our clinic (1993–2013).ResultsWe included 26, 13, and seven patients with IgG, IgG/IgA, and IgA pemphigus, respectively. Patients with IgG/IgA pemphigus did not differ significantly from patients with IgG pemphigus in terms of clinical and microscopic features, DIF findings, anti‐desmoglein antibody values, and treatments required. However, patients with IgG/IgA pemphigus were significantly different from patients with IgA pemphigus regarding intertriginous distribution (P = 0.038) and pustular lesions (P < 0.001), acantholysis (P = 0.043), and presence of intercellular C3 deposits on DIF (P < 0.001).ConclusionComparative clinicopathologic data imply that IgG/IgA pemphigus may best be regarded as a variant of IgG pemphigus and distinct from IgA pemphigus.

AbstractObjectivesWhole‐slide imaging with virtual microscopy is increasingly used as a tool in resident education and training, board certification and maintenance of certification examinations, and diagnostic evaluation. The objective of this study was to determine attitudes toward virtual microscopy compared with traditional glass slide microscopy during a continuing medical education dermatopathology workshop.MethodsTwenty‐three board‐certified, practicing or retired dermatopathologists were given 26 “advanced” cases to review using both virtual microscopy and traditional glass slides. Diagnostic accuracy was not assessed because of the complexity of the cases. Participants were surveyed on: (i) their previous experience with digital imaging; (ii) the quality, ease of use, and speed of slide review; and (iii) overall attitudes toward digital and traditional review.ResultsEqual proportions of participants did and did not have prior experience with digital imaging of histopathologic specimens. Most participants preferred to use both virtual microscopy and traditional microscopy together. The quality of glass slides was rated as better than that of digital images, but virtual microscopy achieved higher ratings for ease of navigation and overall satisfaction.ConclusionsVirtual microscopy is a useful tool for dermatopathology workshops. Specifically, dermatopathologists with and without prior digital slide review experience responded favorably to viewing slides on a computer monitor. Overall satisfaction was high, and the majority of participants indicated that they would use virtual microscopy in the future. These results show a trend toward the acceptance of digital slide review, which supports the inevitable expansion of this practice in an increasingly digitized world.

AbstractBackgroundVirtual microscopy is increasingly being used in dermatopathology educational settings.ObjectiveThe objective is to evaluate diagnostic accuracy and attitudes between virtual microscopy and traditional glass slide microscopy among dermatology residents.MethodsA 48‐question dermatopathology examination was administered to 35 dermatology residents at three different dermatology residency training sites during the 2011–2012 academic year with half (n = 24) of the questions using the gold standard of glass slide microscopy and half (n = 24) using whole, scanned virtual slides. Correct number of questions using glass slides and virtual slides was evaluated. Participants were surveyed regarding previous experience with digital slide imaging; quality, ease of use, and speed of slide review; and overall microscopy preferences.ResultsOverall, diagnostic accuracy was better with glass slides than virtual slides (p = 0.01). However, no statistically significant difference was found in diagnostic accuracy of first‐year trainees (p > 0.99) or trainees with exposure to virtual microscopy greater than two times per month (p = 0.27). There was no overall personal preference for glass slide vs. virtual microscopy.LimitationsDifferent cases and questions were used for glass slides and virtual microscopy.ConclusionsDiagnostic accuracy with virtual microscopy is dependent on year of residency training and prior experience with virtual microscopy.