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ELISA is the superior method for detecting antineutrophil cytoplasmic antibodies in the diagnosis of systemic necrotising vasculitis
  1. Judy Savige1,
  2. Paul Neeson2,
  3. Michele Trevisin2,
  4. Peter Gambel2,
  5. Wendy Pollock3
  1. 1University Department of Medicine, The University of Melbourne, Austin and Repatriation Medical Centre, Heidelberg, Victoria 3084, Australia
  2. 2Division of Investigational Medicine, Austin and Repatriation Medical Centre
  3. 3Gribble's Pathology, 14 Yarra Street, Private Bag 1800, South Yarra, Victoria 3141, Australia

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    Dr Harris's results1 showed that indirect immunofluorescence is a more sensitive technique than antigen specific enzyme linked immunosorbent assay (ELISA) for the diagnosis of systemic necrotising vasculitis (70% v 50%) but that ELISAs have a higher positive predictive value (87% v 76%). It was the greater sensitivity of indirect immunofluorescence that prompted the “International consensus statement on testing and reporting antineutrophil cytoplasmic antibodies (ANCA)”2 to require all laboratories to screen for ANCA by indirect immunofluorescence, but to confirm the specificity of fluorescent sera by ELISA. In our hands, adherence to the minimum requirements of the consensus statement results in a higher positive predictive value than either indirect immunofluorescence or ELISA alone (62% compared with 44% and 50%, respectively). Screening by indirect immunofluorescence has the additional advantages of being a quicker and cheaper technique than using …

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