| Institution: | 1. Department of Statistics, Pusan National University Hospital, Gudeok-ro 179, Seo-gu, Busan 49241, Republic of Korea;2. Department of Laboratory Medicine, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Singil-ro 1, Yeongdeungpo-gu, Seoul 07441, Republic of Korea;3. Department of Rheumatology, Kosin University College of Medicine, Gamcheon-ro 262, Seo-gu, Busan 49267, Republic of Korea;4. Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, Seoul 03722, Republic of Korea;5. Department of Internal Medicine, Kosin University College of Medicine, Gamcheon-ro 262, Seo-gu, Busan 49267, Republic of Korea;6. Department of Internal Medicine, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, Seoul 03722, Republic of Korea |
| Abstract: | ObjectiveThis study aimed to review and compare the analytical and clinical performance of automated indirect immunofluorescence (AIIF) and manual indirect immunofluorescence (MIIF) as anti-nuclear antibody screening assays for patients with systemic rheumatic diseases (SRDs), such as systemic lupus erythematosus (SLE) and systemic sclerosis (SSc).MethodsA systematic literature search was performed in the Medline, Embase, Cochrane, Web of Science, and Scopus databases for studies published before August 2017. A bivariate random effects model was used to calculate the summary diagnostic values.ResultsTwenty-two studies involving 6913 positive and 1818 negative samples of MIIF, as well as 524 combined SRD, 132 SLE, and 104 SSc patients, and 520 controls were available for meta-analysis. The summary positive concordance (PC) of qualitative result between AIIF and MIIF was 93.7%, whereas PCs of total pattern (68.5%; homogeneous, 52.3%; speckled, 56.5%; nucleolar, 52.7%; centromere, 51.4%; nuclear dot, 11.7%) and titer (77.8%) exhibited significantly lower values. The summary clinical sensitivities of AIIF vs. MIIF were 84.7% vs 78.2% for combined SRDs, 95.5% vs. 93.9% for SLE, and 86.5% vs. 83.7% for SSc, respectively. Meanwhile, the summary specificities of AIIF vs. MIIF were 75.6% vs. 79.6% for combined SRDs, 74.2% vs. 83.3% for SLE, and 74.2% vs. 83.3% for SSc, respectively. Although the differences in sensitivity and specificity between AIIF and MIIF were not significant in most subgroups, the summary specificity of SLE and SSc showed statistically significant changes.ConclusionsOur systematic meta-analysis demonstrates that AIIF is comparable to MIIF in distinguishing between the positive and negative results, and screening SRDs based on clinical sensitivities and standardization. However, improvements in the pattern and titer recognition and clinical specificities are necessary. |
