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An analysis of the sensitivity and specificity of MHC-I and MHC-II immunohistochemical staining in muscle biopsies for the diagnosis of inflammatory myopathies.
[inclusion body myositis]
Although
there
have
been
several
previous
reports
of
immunohistochemical
staining
for
MHC
antigens
in
muscle
biopsies
,
there
appears
to
be
a
lack
of
consensus
about
its
routine
use
in
the
diagnostic
evaluation
of
biopsies
from
patients
with
suspected
inflammatory
myopathy
.
Positive
MHC-
I
staining
is
nonspecific
but
is
widely
used
as
a
marker
for
inflammatory
myopathy
,
whilst
the
role
of
MHC-
II
staining
is
not
clearly
defined
.
We
investigated
the
sensitivity
and
specificity
of
MHC-
I
and
MHC-
II
immunostaining
for
the
diagnosis
of
inflammatory
myopathy
in
a
large
group
of
biopsies
from
a
single
reference
laboratory
.
Positive
staining
for
MHC-
I
was
found
to
have
a
high
sensitivity
in
biopsies
from
patients
with
inflammatory
myopathy
but
a
very
low
specificity
,
as
it
was
also
common
in
other
non-
inflammatory
myopathies
and
neurogenic
disorders
.
On
the
other
hand
,
MHC-
II
positivity
had
a
much
higher
specificity
in
all
major
subgroups
of
inflammatory
myopathy
,
especially
inclusion
body
myositis
.
The
findings
indicate
that
the
combination
of
MHC-
I
and
MHC-
II
staining
results
in
a
higher
degree
of
specificity
for
the
diagnosis
of
inflammatory
myopathy
and
that
in
biopsies
with
inflammation
,
positive
MHC-
II
staining
strongly
supports
the
diagnosis
of
an
immune-mediated
myopathy
.
We
recommend
that
immunohistochemical
staining
for
both
MHC-
I
and
MHC-
II
should
be
included
routinely
in
the
diagnostic
evaluation
of
muscle
biopsies
from
patients
with
suspected
inflammatory
myopathy
.
However
,
as
the
sensitivity
and
interpretation
of
MHC
staining
may
depend
on
the
technique
used
,
further
studies
are
needed
to
compare
procedures
in
different
centres
and
develop
standardised
protocols
.
Diseases
Validation
Diseases presenting
"muscle biopsies"
symptom
cadasil
inclusion body myositis
pyruvate dehydrogenase deficiency
zellweger syndrome
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