Diagnostic accuracy measures for vertical and transverse scalp biopsies in cicatricial and non-cicatricial alopecias

摘要

BackgroundScalp biopsy provides worthwhile diagnostic clues to diagnose the noncicatricial or cicatricial type of alopecia. Although a pair of vertically and horizontally sectioned pathology samples would be ideal, the diagnostic yield of vertical (V) or transverse (T) sectioning in different types of cicatricial and non-cicatricial alopecia is not studied. Also, when a single biopsy is submitted and/or the sample is not large enough for a combined V and T sectioning from a single specimen (such as HoVert technique), the decision to make the most appropriate sectioning would be challenging, specifically depending on the type of alopecia suspected clinically.MethodsA prospective study included 194 patients with two 4?mm-punch biopsies, one was sectioned vertically and the other horizontally. The V and T diagnoses were compared with the final diagnosis. The kappa coefficient of agreement, sensitivity, specificity, likelihood ratio (LR), diagnostic odd ratio (DOR) and concordance were estimated.ResultsThe most common types of alopecia were lichen planopilaris (62, 31%), androgenic alopecia (36, 18%) and central centrifugal cicatricial alopecia (26, 13%). The perifollicular inflammatory cell types, presence of pigmented cast and sebaceous hyperplasia were adequately detected in the in T (p?