Performance analysis of automated evaluation of antinuclear antibody indirect immunofluorescent tests in a routine setting

Joyce J. B. C. van Beers, Melanie Hahn, Johanna Fraune, Kathleen Mallet, Christopher Krause, Wymke Hormann, Kai Fechner, Jan G. M. C. Damoiseaux*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


PurposeIndirect immunofluorescence (IIF) on the human epithelial cell-line HEp-2 (or derivatives) serves as the gold standard in antinuclear antibody (ANA) screening. IIF, and its evaluation, is a labor-intensive method, making ANA testing a major challenge for present clinical laboratories. Nowadays, several automated ANA pattern recognition systems are on the market. In the current study, the EUROPattern Suite is evaluated for its use in daily practice in a routine setting.MethodsA total of 1033 consecutive routine samples was used to screen for ANA. Results (positive/negative ANA screening, pattern identification and titer) were compared between software-generated results (EUROPattern) and visual interpretation (observer) of automatically acquired digital images.ResultsConsidering the visual interpretation as reference, a relative sensitivity of 99.3% and a relative specificity of 88.9% were obtained for negative and positive discrimination by the software (EPa). A good agreement between visual and software-based interpretation was observed with respect to pattern recognition (mean kappa: for 7 patterns: 0.7). Interestingly, EPa software distinguished more patterns per positive sample than the observer (on average 1.5 and 1.2, respectively). Finally, a concordance of 99.3% was observed within the range of 1 titer step difference between EPa and observer.ConclusionsThe ANA IIF results reported by the EPa software are in very good agreement with the results reported by the observer with respect to being negative/positive, pattern recognition and titer, making automated ANA IIF evaluation an objective and time-efficient tool for routine testing.
Original languageEnglish
Article number8
Number of pages7
JournalAutoimmunity Highlights
Publication statusPublished - 1 Nov 2018


  • Autoantibodies
  • Antinuclear antibodies (ANA)
  • Automation
  • Indirect immunofluorescence (IIF)
  • Computer-aided microscopy
  • ANA


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