The association of solid-phase assays to immunofluorescence increases the diagnostic accuracy for ANA screening in patients with autoimmune rheumatic diseases

Bizzaro, Nicola; Brusca, Ignazio; Previtali, Giulia; Alessio, Maria Grazia; Daves, Massimo; Platzgummer, Stefan; Cinquanta, Luigi; Paura, Giusy; Infantino, María; Manfredi, Mariangela; Faricelli, Raffaella; Bassetti, D; Musso, Maura; Deleonardi, Gaia; Trevisan, Maria Teresa; Radice, Antonella; Liguori, Marco; Imbastaro, Tiziana; Pesente, Fiorenza; Fabris, Martina; Tonutti, Elio

doi:10.1016/j.autrev.2017.12.007

Cited by 55 publications

(35 citation statements)

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“…This is in line with recent studies that showed that combining an immunoassay with ANA IIF adds value if the results of both tests are correctly judged in the context of the clinical manifestations of the patient (42,43). Furthermore, combining IIF with a solid-phase assay can assist in patient strati cation, especially in case of a low-positive ANA IIF titer (42,44,45). ICAP promotes to integrate the ANA IIF titer and pattern with advice for follow-up testing, taking into account the clinical presentation of the patient (10,46).…”

Section: Discussionsupporting

confidence: 85%

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

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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.

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Section: Discussionsupporting

confidence: 85%

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

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“…Different weights could be assigned to an IIF result depending on the level of positivity. Furthermore, combining IIF with solid-phase assay can help to better stratify patients, especially in case of low-positive IIF titre 9–11…”

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confidence: 99%

Antinuclear antibody as entry criterion for classification of systemic lupus erythematosus: pitfalls and opportunities

Willems

Langhe²,

Westhovens

et al. 2018

Ann Rheum Dis

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Acknowledgements We thank Laura Hendrickx, Marie-Christine Clukkers and Silke Willebrords for expert technical assistance. Contributors PW reviewed all the medical records of the patients included and performed the analysis. EDL, RW, SV and DB took care of the patients and helped with clinical classification of the patients. XB wrote a draft of the manuscript. All authors reviewed the draft and approved the submission of the manuscript.

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“…Two solid-phase monotest methods, called CTD screen, are available today for ANA screening which include a mixture of 15–16 purified native or recombinant antigens among those most frequently recognised by autoantibodies in AARD. We reviewed all the studies that have compared the diagnostic accuracy (sensitivity, specificity and efficiency) of the CTD screen assays versus IIF both in selected cohorts of patients with AARD and in the daily workup6–12 (table 1), reproducing the real-life ANA testing as recommended in their correspondence by Infantino et al 13…”

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confidence: 99%

Can solid-phase assays replace immunofluorescence for ANA screening?

Bizzaro

2018

Ann Rheum Dis

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The association of solid-phase assays to immunofluorescence increases the diagnostic accuracy for ANA screening in patients with autoimmune rheumatic diseases

Cited by 55 publications

References 23 publications

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

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

Antinuclear antibody as entry criterion for classification of systemic lupus erythematosus: pitfalls and opportunities

Can solid-phase assays replace immunofluorescence for ANA screening?

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The association of solid-phase assays to immunofluorescence increases the diagnostic accuracy for ANA screening in patients with autoimmune rheumatic diseases

Cited by 55 publications

References 23 publications

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

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

Antinuclear antibody as entry criterion for classification of systemic lupus erythematosus: pitfalls and opportunities

Can solid-phase assays replace immunofluorescence for ANA screening?

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

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