Titre-specific positive predictive value of antinuclear antibody patterns

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

“…The highest scores for clinical relevance were obtained for the centromere (AC-3) and homogeneous (AC-1) pattern, followed by the nuclear speckled (AC-2,4,5) and cytoplasmic reticular (AC-21) patterns. Especially the centromere pattern is associated with a speci c disease (limited systemic sclerosis, primary biliary cholangitis and Sjögren's syndrome) (16). It is the only pattern that has an almost absolute association with a restrict set of autoantibody speci cities (anti-CENP-B and/or anti-CENP-A).…”

“…Cytoplasmic AC patterns were less frequently used in ANA IIF test result reporting than nuclear AC patterns. Among the competent cytoplasmic patterns ( brillar (AC- 15,16,17), speckled (AC- 18,19,20), reticular/ mitochondria-like (AC-21), polar/Golgi-like (AC-22), rods and rings (AC-23), the rods and rings pattern (AC-23) was the pattern that was least used (63% of the laboratories) ( Table 2).…”

“…The higher the antibody level, the higher the likelihood for disease (13)(14)(15). In addition, the combination of the antibody level and the antibody pattern can also provide helpful information (16).…”

Response to ‘Titre-specific positive predictive value of anti-nuclear antibody patterns’ by Vulsteke et al

“…It is anticipated that if a solid-phase test identifies the disease-specific target autoantigen, the clinical relevance can be further refined. The analyses by Vulsteke et al 2 elegantly illustrate that the positive predictive value (PPV) of the HEp-2 IIFA pattern can be further improved by taking into account the titre of the respective patterns. Given the value and importance of the large dataset (n=9851) obtained in this routine laboratory practice without any selection, except for studying only monospecific nuclear patterns, and the extensive analyses, it is unfortunate that the results have been condensed into a letter.…”

“…Although currently not included in the ICAP classification, Luis Andrade recently presented observations on the HEp-2 substrate that suggested further differentiation within the AC-4 pattern grouping, distinguishing two AC-4 pattern variants with distinct association with anti-SS-A/Ro60 antibodies (14th Dresden Symposium on Autoantibodies). Another limitation of the restricted pattern assignment in the study of Vulsteke et al 2 is the exclusion of the cytoplasmic patterns as it would have been interesting to see how the titre contributes to the clinical interpretation of the cytoplasmic speckled patterns (AC-18, AC-19 and AC-20). In particular, the antisynthetase antibodies reveal only low to moderate titres.…”