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

Springer Science and Business Media LLC - 2020
Lieve Van Hoovels1, Sylvia Broeders2, Edward K. L. Chan3, Luís Eduardo Coelho Andrade4, Wilson de Melo Cruvinel5, Jan Damoiseaux6, M. Viander7, Manfred Herold8, Wim Coucke2, Ingmar Heijnen9, Dimitrios P. Bogdanos10, Jaime Calvo‐Alén11, Catharina Eriksson12, Ana Kozmar13, Liisa Kuhi14, Carolien Bonroy15, Bernard Lauwerys16, Sofie Schouwers17, Laurence Lutteri18, Martine Vercammen19, Miroslav Mayer20, Dina Patel21, William Egner21, Kari Puolakka22, Andrea Tesija-Kuna13, Yehuda Shoenfeld23, Maria José Rego de Sousa24, Marcos Lόpez Hoyos25, Antonella Radice26, Xavier Bossuyt27
1Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
2Sciensano (Formerly Scientific Institute of Public Health), Brussels, Belgium
3Department of Oral Biology, University of Florida, Gainesville, FL, USA
4Rheumatology Division, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Brazil
5Pontifícia Universidade Católica de Goiás, Goiânia, Brazil
6Centraal Diagnostisch Laboratorium, MUMC, Maastricht, The Netherlands
7Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland
8Rheumatology Laboratory, Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
9Medical Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
10Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
11Servicio de Reumatología, Hospital Universitario Araba, Vitoria, Spain
12Department of Clinical Microbiology, Umeå University, Umeå, Sweden
13Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
14Central Laboratory, East Tallin Central Hospital, Tallin, Estonia
15Department of Internal Medicine Ghent University, Ghent, Belgium
16Pôle de Pathologies Rhumatismales Et systémiques, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
17Department of Laboratory Medicine, GZA Hospitals, Antwerp, Belgium
18Department of Clinical Chemistry, University Hospital Liège, Liège, Belgium
19Department of Laboratory Medicine, AZ Sint-Jan Hospital Bruges-Ostend, Bruges, Belgium
20Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
21UK NEQAS Immunology, Northern General Hospital, Immunochemistry & Allergy, Sheffield, UK
22Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland
23Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Saint-Petersburg, Russian Federation
24Centro de Medicina, Laboratorial Germano de Sousa, Lisboa, Portugal
25Servicio de Inmunología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
26UOC Microbiologia e Virologia, Presidio Ospedaliero San Carlo Borromeo, Milan, Italy
27Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium

Tóm tắt

Abstract Background The 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. Methods Two 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. Results 438 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. Conclusion This 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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