Tonutti Elio, Bizzaro Nicola, Morozzi Gabriella, Radice Antonella, Cinquanta Luigi, Villalta Danilo, Tozzoli Renato, Tampoia Marilina, Porcelli Brunetta, Fabris Martina, Brusca Ignazio, Alessio Maria Grazia, Barberio Giuseppina, Sorrentino Maria Concetta, Antico Antonio, Bassetti Danila, Fontana Desré Ethel, Imbastaro Tiziana, Visentini Daniela, Pesce Giampaola, Bagnasco Marcello
Laboratory of Immunopathology and Allergology, University Hospital Udine, P.le S. Maria della Misericordia 15, 33100, Udine, Italy.
Laboratory of Clinical Pathology, San Antonio Hospital, Tolmezzo, Italy.
Auto Immun Highlights. 2016 Dec;7(1):9. doi: 10.1007/s13317-016-0080-3. Epub 2016 Jul 16.
Reflex tests are widely used in clinical laboratories, for example, to diagnose thyroid disorders or in the follow-up of prostate cancer. Reflex tests for antinuclear antibodies (ANA) have recently gained attention as a way to improve appropriateness in the immunological diagnosis of autoimmune rheumatic diseases and avoid waste of resources. However, the ANA-reflex test is not as simple as other consolidated reflex tests (the TSH-reflex tests or the PSA-reflex tests) because of the intrinsic complexity of the ANA test performed by the indirect immunofluorescence method on cellular substrates. The wide heterogeneity of the ANA patterns, which need correct interpretation, and the subsequent choice of the most appropriate confirmatory test (ANA subserology), which depend on the pattern feature and on clinical information, hinder any informatics automation, and require the pathologist's intervention. In this review, the Study Group on Autoimmune Diseases of the Italian Society of Clinical Pathology and Laboratory Medicine provides some indications on the configuration of the ANA-reflex test, using two different approaches depending on whether clinical information is available or not. We further give some suggestions on how to report results of the ANA-reflex test.
反射试验在临床实验室中广泛应用，例如用于诊断甲状腺疾病或对前列腺癌进行随访。抗核抗体（ANA）反射试验作为提高自身免疫性风湿疾病免疫诊断的合理性及避免资源浪费的一种方法，近来受到关注。然而，由于采用间接免疫荧光法在细胞基质上进行的ANA检测本身具有复杂性，ANA反射试验不像其他成熟的反射试验（促甲状腺激素反射试验或前列腺特异性抗原反射试验）那样简单。ANA模式存在广泛的异质性，需要正确解读，且后续取决于模式特征和临床信息的最合适确证试验（ANA亚血清学）的选择，阻碍了任何信息学自动化，需要病理学家的干预。在本综述中，意大利临床病理学和检验医学学会自身免疫疾病研究组根据是否有临床信息，采用两种不同方法，对ANA反射试验的设置给出了一些指导意见。我们还就如何报告ANA反射试验结果给出了一些建议。
