The ANA-reflex test as a model for improving clinical appropriateness in autoimmune diagnostics

Elio Tonutti, Nicola Bizzaro, Gabriella Morozzi, Antonella Radice, Luigi Cinquanta, Danilo Villalta, Renato Tozzoli, Marilina Tampoia, Brunetta Porcelli, Martina Fabris, Ignazio Brusca, Maria Grazia Alessio, Giuseppina Barberio, Maria Concetta Sorrentino, Antonio Antico, Danila Bassetti, Desré Ethel Fontana, Tiziana Imbastaro, Daniela Visentini, Giampaola PesceMarcello Bagnasco

Research output: Contribution to journalArticlepeer-review


Reflex tests are widely used in clinical laboratories, for example, to diagnose thyroid disorders or in the follow-up of prostate cancer. Reflex tests for antinuclear antibodies (ANA) have recently gained attention as a way to improve appropriateness in the immunological diagnosis of autoimmune rheumatic diseases and avoid waste of resources. However, the ANA-reflex test is not as simple as other consolidated reflex tests (the TSH-reflex tests or the PSA-reflex tests) because of the intrinsic complexity of the ANA test performed by the indirect immunofluorescence method on cellular substrates. The wide heterogeneity of the ANA patterns, which need correct interpretation, and the subsequent choice of the most appropriate confirmatory test (ANA subserology), which depend on the pattern feature and on clinical information, hinder any informatics automation, and require the pathologist’s intervention. In this review, the Study Group on Autoimmune Diseases of the Italian Society of Clinical Pathology and Laboratory Medicine provides some indications on the configuration of the ANA-reflex test, using two different approaches depending on whether clinical information is available or not. We further give some suggestions on how to report results of the ANA-reflex test.

Original languageEnglish
Article number9
JournalAutoimmunity Highlights
Issue number1
Publication statusPublished - Dec 1 2016


  • ANA
  • Antinuclear antibodies
  • Immunofluorescence
  • Intracellular specific antigens
  • Pattern
  • Reflex test

ASJC Scopus subject areas

  • Rheumatology
  • Immunology


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