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Diagnostic utility of automated indirect immunofluorescence compared to manual indirect immunofluorescence for anti-nuclear antibodies in patients with systemic rheumatic diseases: A systematic review and meta-analysis

 Jinmi Kim  ;  Woonhyoung Lee  ;  Geun-Tae Kim  ;  Hyon-Suk Kim  ;  Soyoung Ock  ;  In-Soo Kim  ;  Seri Jeong 
 Seminars in Arthritis and Rheumatism, Vol.48(4) : 728-735, 2019 
Journal Title
 Seminars in Arthritis and Rheumatism 
Issue Date
Antibodies, Antinuclear/analysis* ; Fluorescent Antibody Technique, Indirect/methods* ; Humans ; Rheumatic Diseases/diagnosis* ; Rheumatic Diseases/immunology ; Sensitivity and Specificity
Anti-nuclear antibody ; Automation ; Indirect immunofluorescence ; Systemic lupus erythematosus ; Systemic rheumatic disease ; Systemic sclerosis
OBJECTIVE: This study aimed to review and compare the analytical and clinical performance of automated indirect immunofluorescence (AIIF) and manual indirect immunofluorescence (MIIF) as anti-nuclear antibody screening assays for patients with systemic rheumatic diseases (SRDs), such as systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). METHODS: A systematic literature search was performed in the Medline, Embase, Cochrane, Web of Science, and Scopus databases for studies published before August 2017. A bivariate random effects model was used to calculate the summary diagnostic values. RESULTS: Twenty-two studies involving 6913 positive and 1818 negative samples of MIIF, as well as 524 combined SRD, 132 SLE, and 104 SSc patients, and 520 controls were available for meta-analysis. The summary positive concordance (PC) of qualitative result between AIIF and MIIF was 93.7%, whereas PCs of total pattern (68.5%; homogeneous, 52.3%; speckled, 56.5%; nucleolar, 52.7%; centromere, 51.4%; nuclear dot, 11.7%) and titer (77.8%) exhibited significantly lower values. The summary clinical sensitivities of AIIF vs. MIIF were 84.7% vs 78.2% for combined SRDs, 95.5% vs. 93.9% for SLE, and 86.5% vs. 83.7% for SSc, respectively. Meanwhile, the summary specificities of AIIF vs. MIIF were 75.6% vs. 79.6% for combined SRDs, 74.2% vs. 83.3% for SLE, and 74.2% vs. 83.3% for SSc, respectively. Although the differences in sensitivity and specificity between AIIF and MIIF were not significant in most subgroups, the summary specificity of SLE and SSc showed statistically significant changes. CONCLUSIONS: Our systematic meta-analysis demonstrates that AIIF is comparable to MIIF in distinguishing between the positive and negative results, and screening SRDs based on clinical sensitivities and standardization. However, improvements in the pattern and titer recognition and clinical specificities are necessary.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Kim, In-Soo(김인수) ORCID logo https://orcid.org/0000-0003-2801-5514
Kim, Hyon Suk(김현숙) ORCID logo https://orcid.org/0000-0001-5662-7740
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