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Q J Med 1994; 87: 291-299
© 1994 Association of Physicians

research-article

Clinical significance of anti-neutrophil cytoplasm antibodies detected by a standardized indirect immunofluorescence assay

A. DAVENPORT1,, R.J. LOCK2, T.B. WALLINGTON2 and T.G. FEEST1

1Richard Bright Renal Unit, Southmead Hospital Bristol, UK 2Regional Immunology Service, Southmead Hospital Bristol, UK

Address correspondence to Dr A. Davenport, Richard Bright Renal Unit, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB

Received 21 February 1994 Accepted for publication 2 March 1994.

We assessed the use of a standardized anti-neutrophil cytoplasm antibody (ANCA) test in diagnosing Wegener's granulomatosis (WG), microscopic polyarteritis (mPA) and systemic vasculitis (SV). All samples (n = 779) tested for ANCA at our laboratory were identified, and clinical information was obtained for 783/779 patients by questionnaire, and by visits where necessary. The combined prevalence of WG/mPA/SV was 123/738 (17%). The ANCA test was positive in 48/68 WG patients (71 %; 38 cANCA, 10 pANCA), 22/43 mPA patients (51%; 12 cANCA, 10 pANCA) and 3/12 SV patients (25%). WG and mPA patients in remission had similar frequencies of positive ANCA to those with active disease. The sensitivity and specificity for WG (71 % and 80%) and mPA (51% and 80%) were lower than previously reported. In this high-prevalence population, the overall (WG/mPA/SV) positive predictive value was only 40%, and the sensitivity 59%. Only 29% of positive tests were from patients with active disease. Overall, 78% of test results gave a ‘true’ prediction. On this basis, a diagnosis of necrot-izing vasculitis (WG/mPA/SV) can be neither made nor refuted by ANCA test alone.


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