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. 2016 Dec;7(1):1.
doi: 10.1007/s13317-016-0075-0. Epub 2016 Jan 30.

International Consensus on ANA Patterns (ICAP): The Bumpy Road Towards a Consensus on Reporting ANA Results

Free PMC article

International Consensus on ANA Patterns (ICAP): The Bumpy Road Towards a Consensus on Reporting ANA Results

Jan Damoiseaux et al. Auto Immun Highlights. .
Free PMC article


The International Consensus on ANA Patterns (ICAP) was initiated as a workshop aiming to thoroughly discuss and achieve consensus regarding the morphological patterns observed in the indirect immunofluorescence assay on HEp-2 cells. One of the topics discussed at the second ICAP workshop, and addressed in this paper, was the harmonization of reporting ANA test results. This discussion centered on the issue if cytoplasmic and mitotic patterns should be reported as positive or negative. This report outlines the issues that impact on two major different reporting methods. Although it was appreciated by all participants that cytoplasmic and mitotic patterns are clinically relevant, implications for existing diagnostic/classification criteria for ANA-associated diseases in particular hampered a final consensus on this topic. Evidently, a more concerted action of all relevant stakeholders is required. Future ICAP workshops may help to facilitate this action.

Keywords: Anti-nuclear antibodies; Cytoplasmic patterns; Harmonization; Indirect immunofluorescence; Mitotic patterns; Nuclear patterns.

Conflict of interest statement

MF has honoraria and consultation (INOVA Diagnostics Inc and Euroimmun GmbH). Other authors have none. Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent This article does not contain any studies with human participants performed by any of the authors and therefore informed consent is not applicable.


Fig. 1
Fig. 1
Examples illustrating the recommendations for reporting of ANA test results. The report consists of three categories: the type of assay used, the test results (positive/negative, pattern, and antibody level), and the advice for the clinician. In proposal 1 (left), cytoplasmic (and mitotic) patterns are considered ANA positive, while in proposal 2 (right), cytoplasmic (and mitotic) patterns are considered ANA negative. The examples shown illustrate alternate possibilities according to the rules in each proposal for reporting ANA test results. If the test result is negative (a), this is reported as such in both proposals. If only a cytoplasmic staining is observed (b), the result is reported as ANA positive in proposal 1 and as ANA negative in proposal 2. The items positive and negative are highlighted to emphasize the difference in the proposals. In both proposals this result is followed by the statement of the cytoplasmic pattern and antibody level (titer). If a combination of nuclear and cytoplasmic patterns is observed (c), the result is reported as positive in both proposals because of the nuclear staining. According to the rule that patterns are reported in the sequence nuclear—cytoplasmic—mitotic, irrespective of the antibody level, the nuclear pattern is mentioned first even when the antibody level of the cytoplasmic pattern is higher. If a combination of different nuclear patterns is observed (d), the nuclear pattern with the highest antibody level is to be reported first. The advice to the clinician may be similar for the respective situations in both proposals. The lay-out of the report can be adjusted to be compatible with the local hospital information system

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    1. Solomon DH, Kavanaugh AJ, Schur PH. Evidence-based guidelines for the use of immunologic tests: antinuclear antibody testing. Arthritis Rheum. 2002;47:434–444. doi: 10.1002/art.10561. - DOI - PubMed
    1. Mahler M, Fritzler MJ. The clinical significance of the dense fine speckled immunofluorescence pattern on HEp-2 cells for the diagnosis of systemic autoimmune diseases. Clin Dev Immunol. 2012;2012:494356. doi: 10.1155/2012/494356. - DOI - PMC - PubMed
    1. Satoh M, Tanaka S, Ceribelli A, Calise SJ, Chan EK (2015) A Comprehensive overview on myositis-specific antibodies: new and old biomarkers in idiopathic inflammatory myopathy. Clin Rev Allergy Immunol. doi:10.1007/s12016-015-8510-y - PMC - PubMed
    1. Coons AH, Kaplan MH. Localization of antigen in tissue cells; improvements in a method for the detection of antigen by means of fluorescent antibody. J Exp Med. 1950;91:1–13. doi: 10.1084/jem.91.1.1. - DOI - PMC - PubMed
    1. Mahler M, Meroni PL, Bossuyt X, Fritzler MJ. Current concepts and future directions for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. J Immunol Res. 2014;2014:315179. - PMC - PubMed

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