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Cinquanta L, Bizzaro N, Pesce G. Standardization and Quality Assessment Under the Perspective of Automated Computer-Assisted HEp-2 Immunofluorescence Assay Systems. Front Immunol 2021; 12:638863. [PMID: 33717188 PMCID: PMC7947926 DOI: 10.3389/fimmu.2021.638863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/18/2021] [Indexed: 12/11/2022] Open
Abstract
The recent availability of automated computer-assisted diagnosis (CAD) systems for the reading and interpretation of the anti-nuclear antibody (ANA) test performed with the indirect immunofluorescence (IIF) method on HEp-2 cells, has improved the reproducibility of the results and initiated a process of harmonization of this test. Furthermore, CAD systems provide quantitative expression of fluorescence intensity, allowing the introduction of objective quality control procedures to the monitoring of the entire process. The calibration of the reading systems and the automated image interpretation are essential prerequisites for obtaining reproducible and harmonized IIF test results and form the basis for standardization, regardless of the computer algorithms used in the different systems. The use of automated CAD systems, facilitating control procedures, represents a step forward for the quality certification of the laboratory.
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Affiliation(s)
- Luigi Cinquanta
- Laboratorio di Patologia Clinica, IRCCS S.D.N., Napoli, Italy
| | - Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale San Antonio, Tolmezzo-Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Giampaola Pesce
- Laboratorio Diagnostico di Autoimmunologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università Degli Studi di Genova, Genova, Italy
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Choi HW, Kwon YJ, Park JH, Lee SY, Chun S, Won EJ, Lee JH, Choi HJ, Kim SH, Shin MG, Shin JH, Kee SJ. Evaluation of a Fully Automated Antinuclear Antibody Indirect Immunofluorescence Assay in Routine Use. Front Immunol 2020; 11:607541. [PMID: 33343581 PMCID: PMC7746920 DOI: 10.3389/fimmu.2020.607541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
Indirect immunofluorescence assay (IFA) using HEp-2 cells as a substrate is the gold standard for detecting antinuclear antibodies (ANA) in patient serum. However, the ANA IFA has labor-intensive nature of the procedure and lacks adequate standardization. To overcome these drawbacks, the automation has been developed and implemented to the clinical laboratory. The purposes of this study were to evaluate the analytical performance of a fully automated Helios ANA IFA analyzer in a real-life laboratory setting, and to compare the time and the cost of ANA IFA testing before and after adopting the Helios system. A total of 3,276 consecutive serum samples were analyzed for ANA using the Helios system from May to August 2019. The positive/negative results, staining patterns, and endpoint titers were compared between Helios and visual readings. Furthermore, the turnaround time and the number of wells used were compared before and after the introduction of Helios system. Of the 3,276 samples tested, 748 were positive and 2,528 were negative based on visual readings. Using visual reading as the reference standard, the overall relative sensitivity, relative specificity, and concordance of Helios reading were 73.3, 99.4, and 93.4% (κ = 0.80), respectively. For pattern recognition, the overall agreement was 70.1% (298/425) for single patterns, and 72.4% (89/123) for mixed patterns. For titration, there was an agreement of 75.9% (211/278) between automated and classical endpoint titers by regarding within ± one titer difference as acceptable. Helios significantly shortened the median turnaround time from 100.6 to 55.7 h (P < 0.0001). Furthermore, routine use of the system reduced the average number of wells used per test from 4 to 1.5. Helios shows good agreement in distinguishing between positive and negative results. However, it still has limitations in positive/negative discrimination, pattern recognition, and endpoint titer prediction, requiring additional validation of results by human observers. Helios provides significant advantages in routine laboratory ANA IFA work in terms of labor, time, and cost savings. We hope that upgrading and developing softwares with more reliable capabilities will allow automated ANA IFA analyzers to be fully integrated into the routine operations of the clinical laboratory.
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Affiliation(s)
- Hyun-Woo Choi
- Department of Laboratory Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea
| | - Yong Jun Kwon
- Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Ju-Heon Park
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Seung-Yeob Lee
- Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Sejong Chun
- Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju, South Korea.,Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Eun Jeong Won
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Hwasun, South Korea.,Department of Parasitology and Tropical Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jun Hyung Lee
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Hyun-Jung Choi
- Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju, South Korea.,Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Soo Hyun Kim
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Hwasun, South Korea.,Department of Microbiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Myung-Geun Shin
- Department of Laboratory Medicine, Chonnam National University Hwasun Hospital, Hwasun, South Korea.,Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jong-Hee Shin
- Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju, South Korea.,Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Seung-Jung Kee
- Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju, South Korea.,Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
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