title: Antinuclear antibodies giving the 'multiple nuclear dots' or the 'rim-like/membranous' patterns: diagnostic accuracy for primary biliary cirrhosis.
abstract: BACKGROUND
  Serum antinuclear antibodies giving the 'multiple nuclear dots' or the 'rim-like/membranous' patterns are frequently detected by indirect immunofluorescence on HEp-2 cells in patients with primary biliary cirrhosis.
  
  
  OBJECTIVE
  To assess the accuracy of multiple nuclear dot and rim-like/membranous antinuclear antibodies for the diagnosis of primary biliary cirrhosis.
  
  
  METHODS
  Sera from 4371 consecutive patients referred to our laboratory were analysed under code for antinuclear antibodies testing by indirect immunofluorescence on HEp-2 cells.
  
  
  RESULTS
  Review of the clinical records of the 4371 patients allowed identification of 101 patients with antimitochondrial antibody-positive primary biliary cirrhosis and 22 with antimitochondrial antibody-negative variant. Multiple nuclear dot and/or rim-like/membranous patterns were found in 59 (1.3%) of the 4371 patients: 31 antimitochondrial antibody-positive primary biliary cirrhosis, 17 antimitochondrial antibody-negative primary biliary cirrhosis and 11 non-primary biliary cirrhosis. The specificity for primary biliary cirrhosis of both the antinuclear antibodies pattern was 99%. Positive predictive value and likelihood ratio for a positive test were 86% (95% CI: 72.7-94) and 221 (95% CI: 91.7-544) for multiple nuclear dot, 79% (95% CI: 62.2-90.1) and 132 (95% CI: 56.8-312.7) for rim-like/membranous, respectively.
  
  
  CONCLUSIONS
  Multiple nuclear dot and rim-like/membranous antinuclear antibodies are rare findings. Their positivity strongly suggests the diagnosis of primary biliary cirrhosis, irrespective of antimitochondrial antibody status. The high specificity for primary biliary cirrhosis makes them a useful diagnostic tool especially in antimitochondrial antibody-negative patients.
authors.affiliation: Department of Internal Medicine, Cardioangiology, Hepatology, Alma Mater Studiorum, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy. alessandro.granito@unibo.it
authors.forename: A
authors.initials: A
authors.lastname: Granito
authors.forename: P
authors.initials: P
authors.lastname: Muratori
authors.forename: L
authors.initials: L
authors.lastname: Muratori
authors.forename: G
authors.initials: G
authors.lastname: Pappas
authors.forename: F
authors.initials: F
authors.lastname: Cassani
authors.forename: J
authors.initials: J
authors.lastname: Worthington
authors.forename: M
authors.initials: M
authors.lastname: Guidi
authors.forename: S
authors.initials: S
authors.lastname: Ferri
authors.forename: C
authors.initials: C
authors.lastname: DE Molo
authors.forename: M
authors.initials: M
authors.lastname: Lenzi
authors.forename: R W
authors.initials: RW
authors.lastname: Chapman
authors.forename: F B
authors.initials: FB
authors.lastname: Bianchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect / Q000379:methods* / Q000592:standards; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D001323:Autoantibodies