Diagnostic Utility of Immunofluorescence in Oral Lesions: a Systematic Review

Objectives: This systematic review aims to evaluate the diagnostic utility of direct and indirect immunofluorescence of oral lesions in comparison with conventional diagnostic aids.

Material and methods: The diagnostic utility of immunofluorescence in various oral lesions was evaluated. Relevant data from 37 studies, including study characteristics, patient population, test details, and outcomes, were systematically extracted. The search was performed analysing studies across multiple electronic databases including MEDLINE (PubMed), Embase, Scopus and Google Scholar, published from January 15, 2024 until May 15, 2024. Risk of bias was assessed using a modified QUADAS-2 tool.

Results: Most studies demonstrated a low risk of bias in most domains, indicating overall methodological rigor. Comparative analysis showed that direct immunofluorescence (DIF) consistently outperformed indirect immunofluorescence. DIF exhibited high sensitivity and specificity for pemphigus vulgaris (87.8% and 100%), mucous membrane pemphigoid (92% and 98%), and desquamative gingivitis oral ulcers overlapping with oral lichen planus (OLP) (81% and 98.9%). For OLP, DIF showed moderate sensitivity (64.3%) and high specificity (88%).

Conclusions: This review highlights the superior diagnostic utility of direct immunofluorescence over indirect immunofluorescence in evaluating oral lesions. Direct immunofluorescence's higher performance makes it the preferred technique for conditions requiring direct visualization of tissue-bound immune deposits. The combined use of direct immunofluorescence and indirect immunofluorescence can enhance the evaluation and management of various oral pathologies.