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The integration of the detection of systemic sclerosis-associated antibodies in a routine laboratory setting: comparison of different strategies

CAROLIEN BONROY, Vanessa Smith UGent, Katleen Van Steendam, Jens Van Praet UGent, Dieter Deforce UGent, Katrien Devreese UGent and Filip De Keyser UGent (2013) CLINICAL CHEMISTRY AND LABORATORY MEDICINE. 51(11). p.2151-2160
abstract
Background: Detection of systemic sclerosis-associated autoantibodies (SSc-Ab) is mostly restricted to anticentromere and anti-topoisomerase-I. However, antiRNA-polymerase-III and anti-PM/Scl are also important diagnostic markers for the disease supporting their incorporation in the laboratory repertoire. The aim of this study was to compare different testing strategies integrating the identification of these extra SSc-Ab in a routine testing algorithm. Methods: Sera from 144 consecutive SSc-patients and 265 controls were screened for antinuclear antibodies (ANA) by indirect immunofluorescence (ANA IIF) and tested for anti-extractable nuclear antigen (ENA) using five different assays that differ in their ability to detect SSc-Ab [two screening enzyme immunossays (EIA) with antigen mixtures, one multi-parameter line-immunoassay and two EIA with individual antigens]. Results: The application of SSc-Ab testing in cascade with the routine ANA/anti-ENA tests improved diagnostic performance characteristics. Besides the type of algorithm, also the number of antigens included in the screening EIA as well as the expected patient/control ratio, influenced the average expected costs and the number of additional SSc-Ab tests to be performed. In laboratories with an expected patient/control ratio of 0.002, cascade testing was most exploited by the use of a screening EIA that included all SSc-Ab as a secondary test after ANA IIF. Conclusions: Restriction of the performance of additional SSc-Ab assays based on the results of prior ANA/anti-ENA tests is a cost-effective strategy allowing optimized use of laboratory resources with minimal loss in diagnostic capacity.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
ANTINUCLEAR ANTIBODIES, CONNECTIVE-TISSUE DISORDERS, DIAGNOSTIC PERFORMANCE, MULTICENTER VALIDATION, RHEUMATOID-ARTHRITIS, AUTOANTIBODY PROFILE, LUPUS-ERYTHEMATOSUS, REVISED CRITERIA, CLASSIFICATION, SUBSETS, diagnostic algorithm, anti-RNA-polymerase-III, systemic sclerosis, anti-PM/Scl, antinuclear antibodies
journal title
CLINICAL CHEMISTRY AND LABORATORY MEDICINE
Clin. Chem. Lab. Med.
volume
51
issue
11
pages
2151 - 2160
Web of Science type
Article
Web of Science id
000326030500021
JCR category
MEDICAL LABORATORY TECHNOLOGY
JCR impact factor
2.955 (2013)
JCR rank
5/31 (2013)
JCR quartile
1 (2013)
ISSN
1434-6621
DOI
10.1515/cclm-2013-0211
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
4208644
handle
http://hdl.handle.net/1854/LU-4208644
date created
2013-12-13 10:18:40
date last changed
2016-12-19 15:43:16
@article{4208644,
  abstract     = {Background: Detection of systemic sclerosis-associated autoantibodies (SSc-Ab) is mostly restricted to anticentromere and anti-topoisomerase-I. However, antiRNA-polymerase-III and anti-PM/Scl are also important diagnostic markers for the disease supporting their incorporation in the laboratory repertoire. The aim of this study was to compare different testing strategies integrating the identification of these extra SSc-Ab in a routine testing algorithm.
Methods: Sera from 144 consecutive SSc-patients and 265 controls were screened for antinuclear antibodies (ANA) by indirect immunofluorescence (ANA IIF) and tested for anti-extractable nuclear antigen (ENA) using five different assays that differ in their ability to detect SSc-Ab [two screening enzyme immunossays (EIA) with antigen mixtures, one multi-parameter line-immunoassay and two EIA with individual antigens].
Results: The application of SSc-Ab testing in cascade with the routine ANA/anti-ENA tests improved diagnostic performance characteristics. Besides the type of algorithm, also the number of antigens included in the screening EIA as well as the expected patient/control ratio, influenced the average expected costs and the number of additional SSc-Ab tests to be performed. In laboratories with an expected patient/control ratio of 0.002, cascade testing was most exploited by the use of a screening EIA that included all SSc-Ab as a secondary test after ANA IIF.
Conclusions: Restriction of the performance of additional SSc-Ab assays based on the results of prior ANA/anti-ENA tests is a cost-effective strategy allowing optimized use of laboratory resources with minimal loss in diagnostic capacity.},
  author       = {BONROY, CAROLIEN and Smith, Vanessa and Van Steendam, Katleen and Van Praet, Jens and Deforce, Dieter and Devreese, Katrien and De Keyser, Filip},
  issn         = {1434-6621},
  journal      = {CLINICAL CHEMISTRY AND LABORATORY MEDICINE},
  keyword      = {ANTINUCLEAR ANTIBODIES,CONNECTIVE-TISSUE DISORDERS,DIAGNOSTIC PERFORMANCE,MULTICENTER VALIDATION,RHEUMATOID-ARTHRITIS,AUTOANTIBODY PROFILE,LUPUS-ERYTHEMATOSUS,REVISED CRITERIA,CLASSIFICATION,SUBSETS,diagnostic algorithm,anti-RNA-polymerase-III,systemic sclerosis,anti-PM/Scl,antinuclear antibodies},
  language     = {eng},
  number       = {11},
  pages        = {2151--2160},
  title        = {The integration of the detection of systemic sclerosis-associated antibodies in a routine laboratory setting: comparison of different strategies},
  url          = {http://dx.doi.org/10.1515/cclm-2013-0211},
  volume       = {51},
  year         = {2013},
}

Chicago
BONROY, CAROLIEN, Vanessa Smith, Katleen Van Steendam, Jens Van Praet, Dieter Deforce, Katrien Devreese, and Filip De Keyser. 2013. “The Integration of the Detection of Systemic Sclerosis-associated Antibodies in a Routine Laboratory Setting: Comparison of Different Strategies.” Clinical Chemistry and Laboratory Medicine 51 (11): 2151–2160.
APA
BONROY, C., Smith, V., Van Steendam, K., Van Praet, J., Deforce, D., Devreese, K., & De Keyser, F. (2013). The integration of the detection of systemic sclerosis-associated antibodies in a routine laboratory setting: comparison of different strategies. CLINICAL CHEMISTRY AND LABORATORY MEDICINE, 51(11), 2151–2160.
Vancouver
1.
BONROY C, Smith V, Van Steendam K, Van Praet J, Deforce D, Devreese K, et al. The integration of the detection of systemic sclerosis-associated antibodies in a routine laboratory setting: comparison of different strategies. CLINICAL CHEMISTRY AND LABORATORY MEDICINE. 2013;51(11):2151–60.
MLA
BONROY, CAROLIEN, Vanessa Smith, Katleen Van Steendam, et al. “The Integration of the Detection of Systemic Sclerosis-associated Antibodies in a Routine Laboratory Setting: Comparison of Different Strategies.” CLINICAL CHEMISTRY AND LABORATORY MEDICINE 51.11 (2013): 2151–2160. Print.