Affordable Access

Access to the full text

The antinuclear antibody HEp-2 indirect immunofluorescence assay: a survey of laboratory performance, pattern recognition and interpretation

  • Tebo, Anne E.1, 2
  • Schmidt, Robert L.1, 2
  • Kadkhoda, Kamran3
  • Peterson, Lisa K.1, 2
  • Chan, Edward K. L.4
  • Fritzler, Marvin J.5
  • Wener, Mark H.6
  • 1 University of Utah, Salt Lake City, UT, USA , Salt Lake City (United States)
  • 2 ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA , Salt Lake City (United States)
  • 3 Immunopathology Laboratory, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA , Cleveland (United States)
  • 4 University of Florida, Gainesville, FL, USA , Gainesville (United States)
  • 5 University of Calgary, Calgary, AB, Canada , Calgary (Canada)
  • 6 University of Washington, Seattle, WA, USA , Seattle (United States)
Published Article
Autoimmunity Highlights
BioMed Central
Publication Date
Feb 27, 2021
DOI: 10.1186/s13317-020-00146-w
Springer Nature


BackgroundTo evaluate the interpretation and reporting of antinuclear antibodies (ANA) by indirect immunofluorescence assay (IFA) using HEp-2 substrates based on common practice and guidance by the International Consensus on ANA patterns (ICAP).MethodParticipants included two groups [16 clinical laboratories (CL) and 8 in vitro diagnostic manufacturers (IVD)] recruited via an email sent to the Association of Medical Laboratory Immunologists (AMLI) membership. Twelve (n = 12) pre-qualified specimens were distributed to participants for testing, interpretation and reporting HEp-2 IFA. Results obtained were analyzed for accuracy with the intended and consensus response for three main categorical patterns (nuclear, cytoplasmic and mitotic), common patterns and ICAP report nomenclatures. The distributions of antibody titers of specimens were also compared.ResultsLaboratories differed in the categorical patterns reported; 8 reporting all patterns, 3 reporting only nuclear patterns and 5 reporting nuclear patterns with various combinations of other patterns. For all participants, accuracy with the intended response for the categorical nuclear pattern was excellent at 99% [95% confidence interval (CI): 97–100%] compared to 78% [95% CI 67–88%] for the cytoplasmic, and 93% [95% CI 86%–100%] for mitotic patterns. The accuracy was 13% greater for the common nomenclature [87%, 95% CI 82–90%] compared to the ICAP nomenclature [74%, 95% CI 68–79%] for all participants. Participants reporting all three main categories demonstrated better performances compared to those reporting 2 or less categorical patterns. The average accuracies varied between participant groups, however, with the lowest and most variable performances for cytoplasmic pattern specimens. The reported titers for all specimens varied, with the least variability for nuclear patterns and most titer variability associated with cytoplasmic patterns.ConclusionsOur study demonstrated significant accuracy for all participants in identifying the categorical nuclear staining as well as traditional pattern assignments for nuclear patterns. However, there was less consistency in reporting cytoplasmic and mitotic patterns, with implications for assigning competencies and training for clinical laboratory personnel.

Report this publication


Seen <100 times