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lüll Using antineutrophil cytoplasmic antibody testing to diagnose vasculitis: can test-ordering guidelines improve diagnostic accuracy?Mandl LA; Solomon DH; Smith EL; Lew RA; Katz JN; Shmerling RHArch Intern Med 2002[Jul]; 162 (13): 1509-14BACKGROUND: Antineutrophil cytoplasmic antibodies (ANCAs) are strongly associated with Wegener granulomatosis, Churg-Strauss angiitis, microscopic polyangiitis, and pauci-immune glomerulonephritis, referred to collectively as ANCA-associated vasculitis (AAVs). It is unclear how accurate ANCA measurement is for diagnosing AAV in diverse populations or whether proposed ANCA test-ordering guidelines improve test performance. METHODS: We assembled a retrospective case series of hospitalized and ambulatory patients from 2 academic medical centers to assess the diagnostic accuracy of ANCA measurement by enzyme-linked immunosorbent assay in identifying cases of AAV. In addition, we assessed the effect of applying proposed ANCA test-ordering guidelines on test performance. RESULTS: For ANCA testing, sensitivity was 81%; specificity, 98%; positive predictive value, 54%; and negative predictive value, 99%. There were no significant changes in operating characteristics after applying the guideline criteria. Using guidelines would have decreased ANCA test ordering by 23% and would have decreased the false-positive rate by 27%. No cases of AAV would have been missed if only patients fulfilling the guidelines were ANCA tested. CONCLUSION: A positive result on an enzyme-linked immunosorbent assay ANCA test, as it is currently ordered, is not a definitive diagnostic indicator of AAV. Compliance with guidelines for ANCA testing would decrease the number of false-positive results and has the potential to reduce total test expenditures.|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Antibodies, Antineutrophil Cytoplasmic/*blood[MESH]|Diagnosis, Differential[MESH]|Enzyme-Linked Immunosorbent Assay[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Medical Records[MESH]|Middle Aged[MESH]|Practice Guidelines as Topic[MESH]|Predictive Value of Tests[MESH]|Reproducibility of Results[MESH]|Retrospective Studies[MESH]|Sensitivity and Specificity[MESH]|Vasculitis/*diagnosis/immunology[MESH] |