Autoimmune rheumatologic diseases

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Variability in Icap (international Consensus on Ana Patterns) Pattern Reporting in Testing for Antinuclear Antibodies (ana) by Indirect Immunofluorescence Assay (ifa)

Thursday, June 15
5:45 PM - 7:00 PM

ANA IFA pattern may guide clinical evaluation by directing specific antibody testing. ICAP has defined consensus ANA IFA patterns and the level of competency required to identify and interpret them. Laboratories participating in CAP proficiency testing for ANA in 2016 were queried to identify current practices in this interpretation and reporting. Of 638 performing ANA by IFA and reporting a pattern, nearly 100% reported nucleolar, 99% homogeneous and speckled, and 96% centromere, all competent-level ICAP patterns. Only 42% reported nuclear dots (competent-level). 53% reporting nucleolar pattern further described expert-level subpatterns. Of 519 reporting speckled patterns, only 29% reported dense fine speckles, a competent-level pattern reportedly found in normals. "Other" speckled was reported by 44%. 4% did not report speckled pattern at all. Of those reporting nuclear dots, 86% differentiated many nuclear dots and 84% few nuclear dots. Nuclear envelope (expert-level) was reported by 18%. Competent-level cytoplasmic patterns were reported: golgi 69%, mitochondrial 65%, speckles 30%, 17% rods and rings, reticular 12% and polar 10%. Expert-level cytoplasmic patterns were reported: spindle apparatus 59%, centriole 55%, mid body 45%, and lysosomal 32%. Only 54% used an internal fluorescence intensity standard. Pattern reporting practice is variable. Cytoplasmic pattern reporting is limited, possibly reflecting a lack of consensus that cytoplasmic patterns should be reported in an "antinuclear" antibody test. Failure to use an internal fluorescence intensity standard by nearly half of the laboratories may increase inter-assay and inter-observer variation in the threshold for staining positivity and in titer determination.

Stanley J. Naides

Medical Director, Immunology
Quest Diagnostics Nichols Institute

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    Jonathan R. Genzen

    Assistant Professor / Medical Director of Automated Core Laboratory
    University of Utah / ARUP

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      Gyorgy Abel

      Director of Clinical Chemistry, Molecular Diagnostics, and Immunology
      Lahey Clinic Burlington

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        Mu Shan

        Biostatistician
        College of American Pathologists

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          Christine Bashleben

          Senior Technical Specialist, Surveys
          College of American Pathologists

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            Mohammad Qasim Ansari

            Professor of Pathology, Medical Director, Immunopathology Laboratory
            Cleveland Clinic Lerner College of Medicine

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