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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (1): 68-73. doi: 10.19723/j.issn.1671-167X.2026.01.009

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Value of direct immunofluorescence in the diagnosis of oral mucosal pemphigus vulgaris: A retrospective study based on multi-index combined analysis

Yanting CHI1, Hongjie JIANG1,2, Yan CHEN1, Zhixiu XU1,*(), Binbin LI1,*()   

  1. 1. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. The Affiliated Stomatological Hospital of Chongqing Medical University & Chongqing Key Laboratory of Oral Diseases & Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education & Chongqing Municipal Health Commission Key Laboratory of Oral Biomedical Engineering, Chongqing 401147, China
  • Received:2025-09-19 Online:2026-02-18 Published:2026-01-06
  • Contact: Zhixiu XU, Binbin LI

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Abstract:

Objective: To clarify the diagnostic efficacy of various diagnostic methods through multi-index combined analysis, and to explore the core diagnostic value of direct immunofluorescence (DIF) in oral mucosal pemphigus vulgaris (PV). Methods: A total of 53 patients with confirmed oral mucosal PV were included, retrospectively. Their data of DIF, histopathology, serum enzyme-linked immunosorbent assay (ELISA) and clinical diagnosis were systematically analyzed, and diagnostic efficacy of each method was evaluated using indicators, such as sensitivity, specificity, and area under curve (AUC) of the receiver operating characteristic (ROC) curve. Results: The results showed that among the 53 patients, middle-aged and elderly females were predominant, the buccal mucosa was the most common involved site, and most patients had a history of blistering. The positive rate of DIF was 96.23%, mainly manifested as a reticular fluorescent deposition between epithelial spinous cells, demonstrating the highest diagnostic value with a sensitivity of 96.23%, specificity of 100.00%, and AUC of 0.981. Histopathology ranked second, with a sensitivity of 94.34%, a specificity of 100.00%, and an AUC value of 0.972. The ELISA test had a sensitivity of 82.61%, a specificity of 82.35%, and an AUC value of 0.825. Although the sensitivity of clinical diagnosis was acceptable, its specificity was relatively low. Additionally, DIF exhibited complementarity with histopathology, ELISA, and clinical diagnosis, and combined testing could improve diagnostic accuracy. Conclusion: DIF is the "gold standard" for the diagnosis of oral mucosal PV. A comprehensive diagnostic workflow of "clinical manifestation-DIF-histopathology-ELISA" is proposed. This integrated diagnostic system not only significantly improves the accuracy of oral mucosal PV diagnosis but also aligns with the core principles of precision medicine, providing a basis for indivi-dualized treatment.

Key words: Mouth mucosa, Pemphigus, Fluorescent antibody technique, direct, Diagnosis

CLC Number: 

  • R781.5

Figure 1

Histopathological features of oral mucosal pemphigus vulgaris (HE staining) A, intraepithelial blister formation (×20); B, acantholysis (×40); C, blister roof detachment, with epithelial basal cells attached to the surface of connective tissue papillae showing a villous appearance (×100); D, acantholysis with scattered Tzanck cells: swollen round cells with hyperchromatic nuclei, often surrounded by a perinuclear cytoplasmic halo (×200). HE, hematoxylin-eosin."

Figure 2

Direct immunofluorescence of oral mucosal pemphigus vulgaris A, a reticular pattern of IgG deposition is observed in the intercellular spaces of the epithelial stratum spinosum (excitation wavelength 488 nm, emission wavelength 520-530 nm, ×400); B, a reticular pattern of C3 deposition is observed in the intercellular spaces of the epithelial stratum spinosum (excitation wavelength 488 nm, emission wavelength 520-530 nm, ×200)."

Table 1

Diagnosis and treatment status of 2 patients with negative direct immunofluorescence results"

Patient Diagnosis Treatment
Clinical manifestation Histopathology Antibody level by ELISA/(U/mL) Treated with pemphigus protocol Used glucocorticoids Treatment outcome
No.1 Typical Atypical Anti-Dsg3: 93.70 (>20) Anti-Dsg1: 0 (< 20) Yes Yes Marked
No.2 Typical Atypical Anti-Dsg3: 58.44 (>20) Anti-Dsg1: 11.33 (< 20) Yes No Mild

Table 2

Diagnostic performance of various direct immunofluorescence antibody indicators"

Detection indicator Sensitivity Specificity Positive predictive value Negative predictive value Missed diagnosis rate False positive rate
IgG 92.45% 55.00% 84.48% 73.33% 7.55% 45.00%
C3 52.83% 60.00% 77.78% 32.43% 47.17% 40.00%
Fibrinogen 20.75% 75.00% 68.75% 26.32% 79.25% 25.00%
IgA 5.66% 85.00% 50.00% 25.37% 94.34% 15.00%
IgM 1.89% 95.00% 50.00% 26.76% 98.11% 5.00%
DIF 96.23% 100.00% 100.00% 90.91% 3.77% 0.00%

Figure 3

Receiver operating characteristic curve of direct immunofluorescence for the diagnosis of oral mucosal pemphigus vulgaris"

Table 3

Comparison of diagnostic performance of different detection methods in oral mucosal pemphigus vulgaris"

Detection method Sensitivity Specificity AUC
DIF 96.23% 100.00% 0.981
Histopathology 94.34% 100.00% 0.972
ELISA 82.61% 82.35% 0.825
Clinical diagnosis 86.79% 15.00% 0.509
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