title: Automatic reading of ANCA-slides: evaluation of the AKLIDES system.
abstract: The ANCA consensus prescribes screening by indirect immunofluorescence on neutrophils. We evaluated the first automated ANCA-pattern recognition system. C-ANCA (n = 39) and P-ANCA (n = 40) samples were selected from patients with ANCA-associated vasculitis (AAV). Non-AAV controls included sera from healthy controls (n = 40), sera with possible interfering antibodies (n = 46), or miscellaneous ANCA reactivity (n = 31). ANCA slides were analysed by AKLIDES and routine fluorescence microscopy. The C-ANCA pattern was recognized by routine microscopy in 92% and 97% on ethanol- and formalin-fixed slides, respectively. AKLIDES reported C-ANCA in 74% and 95%, respectively. P-ANCA was recognized by routine microscopy on ethanol-fixed neutrophils in 90%, while AKLIDES reported P-ANCA in 80%. Typically, only 65% and 33% of these samples showed the expected C-ANCA on formalin-fixed neutrophils by routine microscopy and AKLIDES, respectively. A C- or P-ANCA pattern was observed on ethanol-fixed neutrophils in 28% and 23% of the controls by routine microscopy and AKLIDES, respectively. Only 5% of the controls revealed C-ANCA on formalin-fixed neutrophils by routine microscopy and AKLIDES. Altogether, automated ANCA-pattern recognition by AKLIDES is promising. Distinction of C- and P-ANCA is good, but sensitivity on ethanol-fixed neutrophils needs improvement. When optimized, pattern recognition software may play an important role in AAV diagnostics.
authors.affiliation: Laboratory of Clinical Immunology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. jan.damoiseaux@mumc.nl
authors.forename: Jan
authors.initials: J
authors.lastname: Damoiseaux
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mallet
authors.forename: Mia
authors.initials: M
authors.lastname: Vaessen
authors.forename: Jos
authors.initials: J
authors.lastname: Austen
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Cohen Tervaert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000097:blood* / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood* / Q000276:immunology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect / Q000379:methods*; D006801:Humans; D008297:Male; D008856:Microscopy, Fluorescence / Q000379:methods; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology / Q000473:pathology; D010363:Pattern Recognition, Automated / Q000379:methods*; D055815:Young Adult
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic