ANA testing in ‘real life’

Infantino, María; Manfredi, Mariangela; Soda, Paolo; Merone, Mario; Afeltra, Antonella; Rigon, Amelia

doi:10.1136/annrheumdis-2018-214615

Cited by 22 publications

(14 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We thank Dr Infantino and colleagues for their comments1 on our paper on assay variability in antinuclear antibody (ANA) testing by indirect immunofluorescence (IIF)2 and subsequent communications that have been published in the journal 3–7. We agree with their observations on assay variability as well as the potential role of computer-aided diagnosis in improving IIF determinations.…”

supporting

confidence: 58%

Response to: ‘ANA testing in “real life”’ by Infantinoetal

Pisetsky

Spencer

Lipsky³

et al. 2018

Ann Rheum Dis

View full text Add to dashboard Cite

Response to: 'ANA testing in "real life"' by Infantino et al We thank Dr Infantino and colleagues for their comments 1 on our paper on assay variability in antinuclear antibody (ANA) testing by indirect immunofluorescence (IIF) 2 and subsequent communications that have been published in the journal. 3-7 We agree with their observations on assay variability as well as the potential role of computer-aided diagnosis in improving IIF determinations. The issue of titre is also important, although changing the threshold from 1:80 to 1:160, while reducing the frequency of false-positive results (ie, results from otherwise healthy subjects), will also likely decrease the frequency of positive results for patients with systemic lupus erythematosus (SLE), impacting on classification and diagnosis. We think that the discussion of our paper has been important in highlighting the limitations of ANA testing in SLE, especially in the setting of clinical trials for 'active, autoantibody positive disease'. These limitations may also affect the utilisation of the newly proposed classification criteria for SLE; these criteria require a positive ANA by human epithelial type 2 cell IIF before a person can be further considered for classification. 8 In this regard, it is important to consider the experience of 'real life testing' by hospital or commercial laboratories as opposed to research studies in which experts make IIF determinations. Thus, while IIF testing has been considered the gold standard for ANA determinations, current approaches have notable variation that may relate to the performance characteristics of kits as well as the subjective nature of these determinations, especially with sera with low titre. In view of the importance of ANA testing for both research and routine clinical care, we look forward to further dialogue on this subject as well as the development and validation of new analytic platforms for ANA determinations in SLE as well as related rheumatic diseases.

show abstract

supporting

confidence: 58%

Response to: ‘ANA testing in “real life”’ by Infantinoetal

Pisetsky

Spencer

Lipsky³

et al. 2018

Ann Rheum Dis

View full text Add to dashboard Cite

show abstract

“…We thank Dr Pacheco and colleagues for their comments1 on our article2 on the variation of testing for antinuclear antibodies (ANA) by indirect immunofluorescence (IIF) in the context of systemic lupus erythematosus (SLE). Along with findings described in other letters,3–8 the observations by Pacheco and colleagues on three different line immunoassays (LIA) and an ELISA indicate that, as in the case of other technologies, LIAs can show considerable discordance among different kits that are currently available. This study also shows that results by LIA can differ from those obtained by an ELISA.…”

mentioning

confidence: 68%

Response to: “Antinuclear autoantibodies: discordance among four different assays” by Pachecoet al

et al. 2018

View full text Add to dashboard Cite

“…The survey con rmed that there is no consensus on whether anti-cytoplasmic antibodies should be considered ANA IIF positive or negative (21,22). Even within Europe, there are divergences between countries, as the geographic block represented by Portugal, Spain, Italy, France and Belgium tend to report exclusive cytoplasmic reactivity as a positive test, whereas countries out of this axis only report nuclear reactivity as a positive test.…”

Section: Discussionmentioning

confidence: 99%

Current laboratory and clinical practices in reporting and interpreting anti-nuclear antibody indirect immunofluorescence (ANA IIF) patterns: results of an international survey. 

Hoovels

Broeders

Chan

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundThe International Consensus on Antinuclear Antibody (ANA) Patterns (ICAP) has recently proposed nomenclature in order to harmonize ANA indirect immunofluorescence (IIF) pattern reporting. ICAP distinguishes competent-level from expert-level patterns. A survey was organized to evaluate reporting, familiarity, and considered clinical value of ANA IIF patterns. MethodsTwo surveys were distributed by European Autoimmunity Standardization Initiative (EASI) working groups, the International Consensus on ANA Patterns (ICAP) and UK NEQAS to laboratory professionals and clinicians. Results438 laboratory professionals and 248 clinicians from 67 countries responded. Except for dense fine speckled (DFS), the nuclear competent patterns were reported by >85% of the laboratories. Except for rods and rings, the cytoplasmic competent patterns were reported by >72% of laboratories. Cytoplasmic IIF staining was considered ANA positive by 55% of clinicians and 62% of laboratory professionals, with geographical and expertise-related differences. Quantification of fluorescence intensity was considered clinically relevant for nuclear patterns, but less so for cytoplasmic and mitotic patterns. Combining IIF with specific extractable nuclear antigens (ENA)/dsDNA antibody testing was considered most informative. Of the nuclear competent patterns, the centromere and homogeneous pattern obtained the highest scores for clinical relevance and the DFS pattern the lowest. Of the cytoplasmic patterns, the reticular/mitochondria-like pattern obtained the highest scores for clinical relevance and the polar/Golgi-like and rods and rings patterns the lowest. ConclusionThis survey confirms that the major nuclear and cytoplasmic ANA IIF patterns are considered clinically important. There is no unanimity on classifying DFS, rods and rings and polar/Golgi-like as a competent pattern and on reporting cytoplasmic patterns as ANA IIF positive.

show abstract

ANA testing in ‘real life’

Cited by 22 publications

References 9 publications

Response to: ‘ANA testing in “real life”’ by Infantinoetal

Response to: ‘ANA testing in “real life”’ by Infantinoetal

Response to: “Antinuclear autoantibodies: discordance among four different assays” by Pachecoet al

Current laboratory and clinical practices in reporting and interpreting anti-nuclear antibody indirect immunofluorescence (ANA IIF) patterns: results of an international survey.

Contact Info

Product

Resources

About

ANA testing in ‘real life’

Cited by 22 publications

References 9 publications

Response to: ‘ANA testing in “real life”’ by Infantinoetal

Response to: ‘ANA testing in “real life”’ by Infantinoetal

Response to: “Antinuclear autoantibodies: discordance among four different assays” by Pachecoet al

Current laboratory and clinical practices in reporting and interpreting anti-nuclear antibody indirect immunofluorescence (ANA IIF) patterns: results of an international survey.&nbsp;

Contact Info

Product

Resources

About

Current laboratory and clinical practices in reporting and interpreting anti-nuclear antibody indirect immunofluorescence (ANA IIF) patterns: results of an international survey.