Pre-bisection of a single skin biopsy does not produce technically inadequate specimens for direct immunofluorescence: A review of 3450 specimens

Ern Loh, April W. Armstrong, Maxwell A Fung

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Background Evaluation of a potential immunobullous disorder typically requires two pieces of tissue obtained by skin biopsy: one placed in formalin for conventional microscopy and a second placed in a different transport medium suitable for direct immunofluorescence (DIF) testing. Clinical practice in this area is not standardized, with dermatologists either obtaining two biopsies or dividing (pre-bisecting) a single biopsy. Some DIF specimens are technically inadequate for interpretation of subepidermal imunobullous disorders because the basement membrane zone is not intact, but it is unknown whether pre-bisecting the tissue increases the risk of compromising the specimen. Objective To investigate whether technically inadequate DIF specimens are associated with pre-bisection.

Methods DIF specimens were consecutively sampled from a single referral center and identified as whole (non-bisected) biopsy specimens or pre-bisected biopsy specimens. The proportion of inadequate specimens was calculated for both groups.

Results A total of 3450 specimens were included. The percentage of inadequate specimens was 5.072% (153/3016) for whole (non-bisected) specimens and 5.299% for pre-bisected specimens. This difference was not significant (chi square, p = 0.84). The study was sufficiently powered to detect a relative risk of 1.685.

Conclusions Pre-bisection of a single skin biopsy does not significantly increase the risk of a technically inadequate specimen for direct immunofluorescence testing.

Original languageEnglish (US)
Pages (from-to)890-892
Number of pages3
JournalJournal of Cutaneous Pathology
Issue number11
StatePublished - Nov 1 2014



  • bullous pemphigoid
  • dermatologist
  • dermatopathology
  • immunopathology

ASJC Scopus subject areas

  • Dermatology
  • Pathology and Forensic Medicine
  • Histology

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