A comparison of a fluorescence enzyme immunoassay versus indirect immunofluorescence for initial screening of connective tissue diseases: Systematic literature review and meta-analysis of diagnostic test accuracy studies

Publication date: Available online 15 April 2019Source: Best Practice & Research Clinical RheumatologyAuthor(s): Michelle Elaine Orme, Carmen Andalucia, Sigrid Sjölander, Xavier BossuytAbstractThe aim was to compare indirect immunofluorescence (IIF) and fluorescence enzyme immunoassay (FEIA) for initial screening of connective tissue diseases (CTDs) and to evaluate whether combining IIF with FEIA adds value.A comprehensive systematic literature review was conducted to identify fully paired, cross-sectional or case–control studies on ANA screening of CTD reporting results for IIF and FEIA. Study quality was assessed using the QUADAS-2 checklist. The reference standard was assessed against established classification criteria. The meta-analysis used hierarchical, bivariate and mixed-effects models to allow test results to vary within and across studies.Eighteen studies of good to fair quality were included in the review. IIF had a higher sensitivity than FEIA [cut-off 1:160, 7 studies, 3251 patients, 0.83 (95% CI 0.75–0.89) versus 0.73 (95% CI 0.64–0.80); cut-off 1:80, 7 studies, 12,311 patients, 0.89 (95% CI 0.84–0.93) versus 0.78 (95% CI 0.71–0.84)] but lower specificity [1:160, 0.81 (95% CI 0.73–0.87) versus 0.94 (95% CI 0.91–0.95); 1:80, 0.72 (95% CI 0.62–0.81) versus 0.94 (95% CI 0.90–0.96)]. A double-positive test had a higher likelihood ratio (LR) for CTD (26.2 (95% CI 23.0–29.9)) than a single positive test (14.4 (95% CI 13.1–15.9) FEIA+, 5.1 (95% ...

Source: Best Practice and Research Clinical Rheumatology - April 16, 2019 Category: Rheumatology Source Type: research