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. 2019 Jul 25;10(1):6.
doi: 10.1186/s13317-019-0116-6. eCollection 2019 Dec.

The clinical significance of atypical indirect immunofluorescence patterns on primate cerebellum in paraneoplastic antibody screening

Joris Godelaine  1   2 , Xavier Bossuyt  2   3 , Koen Poesen  1   2
Affiliations

The clinical significance of atypical indirect immunofluorescence patterns on primate cerebellum in paraneoplastic antibody screening

Joris Godelaine et al. Auto Immun Highlights. .

Abstract

Purpose: Screening for paraneoplastic antibodies is often performed by means of indirect immunofluorescence on primate cerebellar slices. However, atypical immunofluorescence patterns, i.e. patterns that are not specifically related to paraneoplastic antibodies, are often reported. The clinical significance of these patterns is not clear. Therefore, the purpose of this study was to determine the significance and diagnostic value-in terms of a paraneoplastic neurological syndrome or other neurological disease being diagnosed in the patient-of such atypical immunofluorescence screening patterns on primate cerebellum.

Methods: This study is a retrospective single center study including atypical indirect immunofluorescence screening patterns of patients with a negative or absent typing assay for intraneuronal and anti-amphiphysin paraneoplastic antibodies. Patients with a positive typing assay or without final diagnosis were excluded. Included patients were grouped according to (i) reported immunofluorescence pattern and (ii) established diagnosis, after which contingency table analyses were performed to investigate an interrelation between reported pattern and diagnostic group.

Results: In 3.7% of cases, patients with an atypical pattern obtained a final diagnosis of a paraneoplastic neurological syndrome. The presence of atypical patterns was more prominent in patients with epilepsy or peripheral neuropathies (p Monte Carlo simulation = 0.026), without, however, adding any diagnostic information.

Conclusions: An atypical indirect immunofluorescence pattern on primate cerebellum in the screening for paraneoplastic antibodies has only very minor relevance with respect to paraneoplastic neurological syndromes or any other neurological disease, recommending clinicians to interpret the results of positive screening assays for such antibodies with care.

Keywords: Antineuronal antibodies; Indirect immunofluorescence; Paraneoplastic neurological syndromes; Primate cerebellum; Screening assay.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Location of antineuronal antibody targets. Antibodies directed against intracellular antigens (excluding anti-GAD antibodies) generate specific indirect immunofluorescence patterns on primate cerebellum. R, receptor. Illustration made with Lucidchart (http://www.lucidchart.com)
Fig. 2
Fig. 2
Number of reported immunofluorescence patterns for each diagnostic group. Illustration made with Microsoft Excel 2016
See this image and copyright information in PMC

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