TY - JOUR
T1 - The ANA-reflex test as a model for improving clinical appropriateness in autoimmune diagnostics
AU - Tonutti, Elio
AU - Bizzaro, Nicola
AU - Morozzi, Gabriella
AU - Radice, Antonella
AU - Cinquanta, Luigi
AU - Villalta, Danilo
AU - Tozzoli, Renato
AU - Tampoia, Marilina
AU - Porcelli, Brunetta
AU - Fabris, Martina
AU - Brusca, Ignazio
AU - Alessio, Maria Grazia
AU - Barberio, Giuseppina
AU - Sorrentino, Maria Concetta
AU - Antico, Antonio
AU - Bassetti, Danila
AU - Fontana, Desré Ethel
AU - Imbastaro, Tiziana
AU - Visentini, Daniela
AU - Pesce, Giampaola
AU - Bagnasco, Marcello
PY - 2016/12/1
Y1 - 2016/12/1
N2 - 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.
AB - 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.
KW - ANA
KW - Antinuclear antibodies
KW - Immunofluorescence
KW - Intracellular specific antigens
KW - Pattern
KW - Reflex test
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U2 - 10.1007/s13317-016-0080-3
DO - 10.1007/s13317-016-0080-3
M3 - Article
AN - SCOPUS:84979243794
VL - 7
JO - Autoimmunity Highlights
JF - Autoimmunity Highlights
SN - 2038-0305
IS - 1
M1 - 9
ER -