Test Id : CIB
Cutaneous Direct Immunofluorescence Assay, Varies
Useful For
Suggests clinical disorders or settings where the test may be helpful
Confirming a diagnosis of bullous pemphigoid, cicatricial pemphigoid, pemphigoid gestationis and other variants of pemphigoid, all types of pemphigus, including paraneoplastic pemphigus (paraneoplastic multiorgan syndrome), dermatitis herpetiformis, linear IgA bullous dermatosis, chronic bullous disease of childhood, epidermolysis bullosa acquisita, porphyria cutanea tarda, bullous eruption of lupus erythematosus, and atypical or mixed forms of bullous disease, systemic lupus erythematosus, cutaneous lupus erythematosus, or other variants, vasculitis, lichen planus, and other inflammatory diseases
This test is not useful for diagnosis of malignancies involving the skin.
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For information see Pathology Consultation Ordering Algorithm
Method Name
A short description of the method used to perform the test
Direct Immunofluorescence Assay (IFA)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Anti-Epithelial Antibody
Anti-Skin Basement Membrane
Basement Membrane
Biopsy
Blistering Disease
Bullous Disease
Bullous Pemphigoid
Chronic Bullous Disease of Childhood
CI-B
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
Lupus Erythematosus (LE)
Oral Ulcers
Paraneoplastic Pemphigus
Pemphigoid
Pemphigus
Porphyria Cutanea Tarda
Skin Basement Membrane Antibodies
Skin Biopsy
Urticaria
Vasculitis
Cutaneous Immunofluorescence
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For information see Pathology Consultation Ordering Algorithm
Specimen Type
Describes the specimen type validated for testing
Varies
Necessary Information
All requisition and supporting information must be submitted in English.
Each of the following items is required:
1. All requisitions must be labeled with:
-Patient name, date of birth, and medical record number
-Name and phone number of the referring pathologist or ordering provider
-Anatomic site and collection date
2. A suspected diagnosis and reason for testing
See Specimen Required - Recommended Biopsy Site Selection Based on Disease State for how to label biopsy site specimens.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Processed as 1 specimen: Two or more biopsies from same site and sent in 1 specimen vial.
Processed as 2 specimens: Two or more biopsies from different sites require separate specimen vials.
Note: These can be ordered together. Tests performed on each site will be billed accordingly.
Transport Medium Method
Specimen Type: Tissue
Supplies: Michel's Transport Media for Immunofluorescent Testing on Tissue (T321)
Sources: Skin or 1 of the following mucosae: oral (oropharyngeal), nasal, genital, esophageal, conjunctival, laryngeal, or epiglottis
Container/Tube: Screw-capped container or vial containing transport medium (Michel's, also called Zeus media)
Specimen Volume: 2- to 8-mm punch specimen, intact or bisected; excisional biopsy specimen intact or bisected
Collection Instructions:
1. Collect biopsy of skin or mucosa avoiding old lesions (including facial), ulcers, erosions, or bullae. Refer to Recommended Biopsy Site Selection Based on Disease State below.
2. Immediately place specimen into a labeled vial of transport medium and seal tightly.
Acceptable
Snap-Frozen Method
Specimen Type: Tissue
Sources: Skin or 1 of the following mucosae: oral (oropharyngeal), nasal, genital, esophageal, conjunctival, laryngeal, or epiglottis
Container/Tube: Plastic vial
Specimen Volume: 2-8 mm punch specimen, intact or bisected; excisional biopsy specimen, intact or bisected
Collection Instructions:
1. Collect biopsy of skin or mucosa avoiding old lesions (including facial), ulcers, erosions, or bullae. Refer to Recommended Biopsy Site Selection Based on Disease State below.
2. Immediately place 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.
3. Immediately wrap specimen carefully in aluminum foil. At no time should the specimen be allowed to thaw.
4. Place the wrapped specimen into the prelabeled plastic vial and seal tightly. Ship frozen.
Recommended Biopsy Site Selection Based on Disease State
1. Pemphigus and pemphigoid groups (including linear IgA bullous dermatosis and chronic bullous disease of childhood): Biopsy erythematous perilesional skin or mucosa. Avoid erosions, ulcers, and bullae while obtaining tissue adjacent to active lesions. Label as perilesional skin.
2. Dermatitis herpetiformis: Biopsy normal-appearing skin, 0.5-1 cm away from lesion. Label as perilesional skin.
3. Lupus erythematosus: Involved areas of skin such as erythematous or active borders are preferred biopsy sites to confirm the diagnosis of lupus erythematosus, either discoid or systemic. Label as involved skin. Avoid ulcers, old lesions, and facial lesions, if possible. Uninvolved, nonexposed skin is the preferred site to detect a lupus band as may be found in systemic lupus erythematosus. Should unexposed skin be desired, buttock or medial thigh is suggested. Label as uninvolved, nonexposed skin.
4. Mixed connective tissue disease: Biopsy as for lupus erythematosus except when sclerodermoid features are present. For sclerodermoid features, biopsy inflamed area. Label as involved or uninvolved, exposed or nonexposed skin.
5. Vasculitis and urticaria: The erythematous or active border of a new lesion is preferred. Avoid old lesions and ulcers. Label as involved skin. If appropriate, skin lesion is not present, diagnosis may sometimes be made from uninvolved skin.
6. Porphyria: Biopsy involved skin. Avoid old lesions and ulcers. Label as involved skin.
7. Lichen planus and lichenoid reactions: Biopsy involved skin. Avoid old lesions and ulcers. Label as involved skin.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
See Specimen Required
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Biopsy from lung, kidney, muscle, salivary gland, veins, synovial tissue, bronchial tissue, or bronchial lavage Biopsy in formalin fixation Frozen in alcohol Trumps media Glutaraldehyde | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Ambient (preferred) | 30 days | |
| Refrigerated | 30 days | ||
| Frozen | 120 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Confirming a diagnosis of bullous pemphigoid, cicatricial pemphigoid, pemphigoid gestationis and other variants of pemphigoid, all types of pemphigus, including paraneoplastic pemphigus (paraneoplastic multiorgan syndrome), dermatitis herpetiformis, linear IgA bullous dermatosis, chronic bullous disease of childhood, epidermolysis bullosa acquisita, porphyria cutanea tarda, bullous eruption of lupus erythematosus, and atypical or mixed forms of bullous disease, systemic lupus erythematosus, cutaneous lupus erythematosus, or other variants, vasculitis, lichen planus, and other inflammatory diseases
This test is not useful for diagnosis of malignancies involving the skin.
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For information see Pathology Consultation Ordering Algorithm
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, or fibrinogen.
Biopsy specimens are examined for the presence of bound IgG, IgM, IgA, third component of complement (C3), fibrinogen, and IgG4.
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.
An interpretive report will be provided.
Interpretation
Provides information to assist in interpretation of the test results
A board-certified Dermatopathologist will review and interpret the test results in correlation with other clinical findings as provided.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This test is an adjunctive test to be interpreted in the context of clinical information, histologic studies, and serologic studies as clinically indicated.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Jain S, Basavaraj V, Vimala MG. Utility of direct immunofluorescence studies in subclassification of autoimmune sub-epidermal bullous diseases: A 2-year study in a tertiary care hospital. Turk Patoloji Derg. 2016;32(2):91-98. doi:10.5146/tjpath.2015.01345
2. Diercks GF, Pas HH, Jonkman MF. Immunofluorescence of autoimmune bullous siseases. Surg Pathol Clin. 2017;10(2):505-512. doi:10.1016/j.path.2017.01.011
3. Kershenovich R, Hodak E, Mimouni D. Diagnosis and classification of pemphigus and bullous pemphigoid. Autoimmun Rev. 2014;13(4-5):477-481. doi:10.1016/j.autrev.2014.01.011
4. Buschman KE, Seraly M, Thong HY, Deng JS, Draviam RP, Abernethy JL. A predominant IgG4 subclass may be responsible for false-negative direct immunofluorescence in bullous pemphigoid. J Cutan Pathol. 2002;29(5):282-286. doi:10.1034/j.1600-0560.2002.290504.x
5. Lamb PM, Patton T, Deng JS. The predominance of IgG4 in prodromal bullous pemphigoid. Int J Dermatol. 2008;47(2):150-153. doi:10.1111/j.1365-4632.2008.03361.x
Method Description
Describes how the test is performed and provides a method-specific reference
Frozen sections of biopsy specimens are brought to ambient temperature, air dried, washed with phosphate-buffered saline (PBS), and then layered with fluorescein isothiocyanate (FITC)-conjugated rabbit antihuman IgG, IgA, IgM, C3, fibrinogen, and IgG4. These slides are incubated in a moist chamber at ambient temperature. The sections are then washed with PBS, mounted in buffered glycerine, and viewed under a fluorescence microscope.(Mysorekar VV, Sumathy TK, Shyam Prasad AL. Role of direct immunofluorescence in dermatological disorders. Indian Dermatol Online J. 2015;6[3]:172-180. doi:10.4103/2229-5178.156386)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
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
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
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 instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
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 Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
Per biopsy site:
88346
88350 x 5
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| CIB | Cutaneous Direct IFA, Biopsy | In Process |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 71145 | Interpretation | 66121-5 |
| 71146 | Participated in the Interpretation | No LOINC Needed |
| 71147 | Report electronically signed by | 19139-5 |
| 71610 | Addendum | 35265-8 |
| 71855 | Case Number | 80398-1 |