Automated antinuclear immunofluorescence antibody analysis is a reliable approach in routine clinical laboratories

• Published in: Clinical chemistry and laboratory medicine Vol. 55; no. 12; pp. 1922 - 1930
• Main Authors: Zheng, Bing, Li, Enling, Zhu, Haoming, Lu, Jingbo, Shi, Xinming, Zhang, Jie, Li, Min
• Format: Journal Article
• Language: English
• Published: Germany De Gruyter 26.10.2017; Walter De Gruyter & Company
• Subjects: Antibodies; Antibodies, Antinuclear - blood; Antinuclear antibodies; antinuclear antibodies (ANAs); Automation; Automation - standards; Clinical Laboratory Techniques - standards; Connective Tissue Diseases - blood; Connective Tissue Diseases - diagnosis; Consistency; Diagnostic Tests, Routine - standards; Digital imaging; Fluorescent Antibody Technique, Indirect - standards; Humans; Immunofluorescence; indirect immunofluorescence; Laboratories; Microscopy; Nucleoli; Pattern recognition; Quality Control; Technicians; value-added ANA report; automation; antinuclear antibodies (ANAs); indirect immunofluorescence; value-added ANA report
• DOI: 10.1515/cclm-2017-0050
• ISSN: 1434-6621

Indirect immunofluorescence (IIF) assays are recommended as the gold standard method for the detection of antinuclear antibodies (ANAs). This study aimed to investigate the reliability of an automated system. We compared 3745 serum samples using NOVA View archived images with manual analysis via microscopy. A custom cutoff value was established to distinguish ANA titers and was validated in two clinical laboratories. The automatic ANA pattern recognition system was evaluated, and all ANA-positive sera were subjected to two commercial ANA IIF kits to compare the consistency of the pattern interpretation results. For inconsistent patterns, a third ANA IIF testing kit was utilized. Agreement of the interpretation of the ANA IIF test using the platform of NOVA View and manual microscopy was 96.9%. The local cutoff value to discriminate ANA titers in four main ANA patterns was calculated based on 1390 serum samples. In our laboratory, the titer prediction accuracy was superior to the preset cutoff in NOVA View (p<0.01); the performance was similar in another laboratory (p=0.11). The automatic pattern recognition accuracies of speckled, homogeneous, centromere, nucleolar and nuclear dot patterns were 62.7%, 57.4%, 92.6%, 30.5% and 27.3%, respectively. The consistency of the pattern interpretation results between INOVA and MBL kits was 95.3%. It is necessary to establish a custom value-added ANA report. However, confirmation of the digital immunofluorescence images by expert technicians was essential, and suspect results of an ANA pattern should be reconfirmed by another commercial ANA IIF kit to achieve more reliable results.