Test ID: 8041
Cutaneous Immunofluorescence, Biopsy
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Confirming a diagnosis of bullous pemphigoid, cicatricial pemphigoid, variants of pemphigoid, all types of pemphigus, dermatitis herpetiformis, linear IgA bullous dermatosis, chronic bullous disease of childhood, epidermolysis bullosa acquisita, porphyria cutanea tarda, bullous eruption of lupus erythematosus, herpes gestationis, and atypical or mixed forms of bullous disease, systemic lupus erythematosus, discoid lupus erythematosus, or other variants, vasculitis, lichen planus, and other inflammatory diseases.
Testing Algorithm Delineates situation(s) when tests are added to the initial order. This includes reflex and additional tests.
See Celiac Disease Diagnostic Testing Algorithm in Special Instructions.
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
Direct Immunofluorescence Staining of Cryostat-Prepared Skin Biopsy Sections for IgG, IgM, IgA, C3, and Fibrinogen Deposition
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Anti-Skin Basement Membrane
Basement Membrane
Biopsy
Blistering Disease
Bullous Disease
Bullous Pemphigoid
Chronic Bullous Disease of Childhood
Cicatricial Pemphigoid
Connective Tissue Disease
Dermatitis herpetiformis
Dermatoimmunopathology
Dermatopathology
Direct Immunofluorescence
Epidermal Cell Surface Antibody
Epidermal Fluorescence Antibody
Epidermolysis Bullosa Acquisita
Immunodermatology
Immunofluorescence Antibodies
Immunopathology
Intercellular Substance Antibody
Lichen Planus
Linear IgA Bullous Dermatosis
Oral Ulcers
Paraneoplastic Pemphigus
Pemphigoid
Pemphigus
Porphyria Cutanea Tarda
Skin Basement Membrane Antibodies
Skin Biopsy
Urticaria
Vasculitis
CI-B
Lupus Erythematosus (LE)
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Forms: If not ordering electronically, submit a Dermatopathology/Immunodermatology Request Form (Supply T060) with the specimen.
Biopsy site; whether biopsy was obtained from sun-exposed vs. unexposed skin; whether it is from perilesional, involved, or uninvolved skin; and date of collection are required.
Specimen Type: Tissue
Sources: Skin, oral mucosa, conjunctiva, or esophagus
Two or more biopsies from same site and sent in 1 specimen vial will be processed as 1 specimen. Two or more biopsies from different sites require separate orders and separate specimen vials.
Transport Medium Method
Container/Tube: Transport medium (Michels or Zeus media) (Supply T321)
Specimen Volume: 4 mm
Collection Instructions:
1. Collect punch biopsy of uninvolved or involved skin as per complete instructions in Collection and Transport in Cutaneous Immunofluorescence Testing in Special Instructions.
2. Skin or mucosal specimen can be sent.
3. Immediately drop specimen into provided vial of transport medium and seal tightly.
Specimen Stability Information: Ambient (preferred)/Refrigerated
Additional Information: The practical value of using transport medium is recognized for direct immunofluorescence testing.
Snap-Frozen Method
Container/Tube: Plastic vial
Specimen Volume: 4 mm
Collection Instructions:
1. Collect punch biopsy of uninvolved or involved skin as per complete instructions in Collection and Transport in Cutaneous Immunofluorescence Testing in Special Instructions.
2. Skin or mucosal specimen can be sent.
3. Immediately drop specimen into liquid nitrogen and allow to freeze thoroughly (do not allow specimen to desiccate). If liquid nitrogen is not available, specimen may be frozen by placing it on a small square of aluminum foil on a block of dry ice. Liquid nitrogen is preferred.
4. Immediately wrap specimen carefully in aluminum foil. At no time should the specimen be allowed to thaw. Wrap as you would a party favor or a piece of taffy candy.
5. Place the wrapped specimen into the pre-labeled plastic vial and seal tightly.
Specimen Stability Information: Frozen
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | Specimen fixed in formalin |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Tissue | Varies | |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Skin or mucosal tissue from patients with autoimmune bullous diseases, connective tissue disease, vasculitis, lichen planus, and other inflammatory conditions often contains bound immunoglobulin, complement, and/or fibrinogen.
Biopsy specimens are examined for the presence of bound IgG, IgM, IgA, third component of complement (C3), and fibrinogen.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Report includes description and interpretation of staining patterns. See Results of IF Testing in Cutaneous Immunofluorescence Testing in Special Instructions.
Interpretation Provides information to assist in interpretation of the test results
In pemphigus, direct immunofluorescence (IF) testing will show deposition of IgG, or rarely IgA, and often complement C3 (C3) at the cell surface (intercelluar substances).
In bullous pemphigoid and cicatricial pemphigoid, direct IF study demonstrates deposition of IgG and C3 at the basement membrane zone (BMZ) in a linear pattern.
In cicatricial pemphigoid, a disease uncommonly associated with circulating anti-BMZ antibodies, direct IF testing is particularly useful.
Biopsy from patients with dermatitis herpetiformis will show IgA concentrated in dermal papillae and/or in a granular pattern at the BMZ.
In lupus erythematosus (LE), there are granular deposits of immunoglobulin and complement at the BMZ ("lupus band"). A lupus band is typically found in lesional skin from patients with a variety of forms of LE; similar findings in biopsies of uninvolved "normal" skin are consistent with systemic LE.
Biopsy of early inflammatory purpuric lesions of vasculitis will show immunoglobulins and/or complement in dermal vessels.
The diagnostic value of direct IF testing is illustrated in the chart Results of IF Testing under Cutaneous Immunofluorescence Testing in Special Instructions.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
In most cases, diagnosis should be confirmed by correlating the results of immunofluorescence testing with clinical information and histologic studies.
Not useful for diagnosis of malignancies involving the skin.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Immunopathology of the Skin. Edited by EH Beutner, TP Chorzelski, V Kumar. Third edition. New York, NY, Wiley Medical Publication, 1987
Method Description Describes how the test is performed and provides a method-specific reference
Frozen sections of biopsy specimens are overlaid with fluorescein-conjugated antisera, incubated, and interpreted with a fluorescence microscope. Sections from all biopsies are stained with antisera specific for IgG, IgM, IgA, C3, and fibrinogen.(Immunopathology of the Skin. Edited by EH Beutner, TP Chorzelski, V Kumar. Third edition. New York, NY, Wiley Medical Publication, 1987)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday; 7 a.m.-5 p.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
88323-Pathology consultation
88346 x 5-Direct immunofluorescent staining
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 18603 | Accession Number | N/A |
| 18604 | Referring Pathologist/Physician | 46608-6 |
| 18605 | Ref Path/Phys Address | In Process |
| 18606 | Anatomic Site of Tissue: | 39111-0 |
| 18607 | Clinical Impression: | In Process |
| 18285 | Tissue: | 31208-2 |
| 18609 | Interpretation: | In Process |
| 18608 | Comment: | 48767-8 |
| 18610 | SP Signing Pathologist: | N/A |
| 18611 | *Previous Report Follows* | N/A |
| 18612 | Addendum: | 35265-8 |
| 19191 | Addendum Comment: | 22638-1 |
| 18613 | Addendum Pathologist: | 19139-5 |
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