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. 2019 Jul;78(7):879-889.
doi: 10.1136/annrheumdis-2018-214436. Epub 2019 Mar 12.

Clinical relevance of HEp-2 indirect immunofluorescent patterns: the International Consensus on ANA patterns (ICAP) perspective

Jan Damoiseaux  1 , Luis Eduardo Coelho Andrade  2 , Orlando Gabriel Carballo  3   4 , Karsten Conrad  5 , Paulo Luiz Carvalho Francescantonio  6 , Marvin J Fritzler  7 , Ignacio Garcia de la Torre  8 , Manfred Herold  9 , Werner Klotz  10 , Wilson de Melo Cruvinel  11 , Tsuneyo Mimori  12 , Carlos von Muhlen  13 , Minoru Satoh  14 , Edward K Chan  15
Affiliations

Clinical relevance of HEp-2 indirect immunofluorescent patterns: the International Consensus on ANA patterns (ICAP) perspective

Jan Damoiseaux et al. Ann Rheum Dis. 2019 Jul.

Abstract

The indirect immunofluorescence assay (IIFA) on HEp-2 cells is widely used for detection of antinuclear antibodies (ANA). The dichotomous outcome, negative or positive, is integrated in diagnostic and classification criteria for several systemic autoimmune diseases. However, the HEp-2 IIFA test has much more to offer: besides the titre or fluorescence intensity, it also provides fluorescence pattern(s). The latter include the nucleus and the cytoplasm of interphase cells as well as patterns associated with mitotic cells. The International Consensus on ANA Patterns (ICAP) initiative has previously reached consensus on the nomenclature and definitions of HEp-2 IIFA patterns. In the current paper, the ICAP consensus is presented on the clinical relevance of the 29 distinct HEp-2 IIFA patterns. This clinical relevance is primarily defined within the context of the suspected disease and includes recommendations for follow-up testing. The discussion includes how this information may benefit the clinicians in daily practice and how the knowledge can be used to further improve diagnostic and classification criteria.

Keywords: ANA patterns; antinuclear antibodies; clinical interpretation; indirect immunofluorescence.

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Conflict of interest statement

Competing interests: The ICAP committee is funded by unrestricted educational grants by several in vitro diagnostics companies (for details see www.anapatterns.org/sponsors.php). JD has received lecture fees from Euroimmun and Thermo Fisher. MJF is a consultant to Inova Diagnostics and Werfen International; none of the other authors declare any competing interest.

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