Vasculitis & polymyalgia rheumatica
ANCA testing in real-world clinical practice: diagnostic performance and predictive value in a Spanish cohort
Authors' conclusion
ANCA IIF retains good diagnostic efficiency and a very high NPV for GPA and MPA, but has low PPV, particularly when tested for nonspecific symptoms.
Study context
- Population
- All patients with an ANCA request at a tertiary hospital over a 4-year period, Spain
- Participants
- 5,157 patients
- Comparison
- Indirect immunofluorescence (IIF) ANCA testing, alone and restricted to typical patterns or combined with chemiluminescent immunoassay (CLIA) anti-PR3/anti-MPO, for granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA)
- Outcome
- Diagnostic performance of IIF ANCA testing for GPA and MPA in routine clinical practice
Methodological detailsretrospective, single tertiary hospital, 4-year period
- Retrospective
- Single tertiary hospital
- 4-year period
Performance
As reported in the abstract
Diagnostic performance for GPA and MPA
| Test or model | Sensitivity | Specificity | PPV | NPV |
|---|---|---|---|---|
| IIF | 93% | 88% | 6.1% | 99.9% |
| IIF typical patterns | — not stated in the abstract | 96.8% | — not stated in the abstract | — not stated in the abstract |
| IIF + CLIA | — not stated in the abstract | 99.6% | — not stated in the abstract | — not stated in the abstract |
Sensitivity
IIF93%
IIF typical patterns— not stated in the abstract
IIF + CLIA— not stated in the abstract
Specificity
IIF88%
IIF typical patterns96.8%
IIF + CLIA99.6%
PPV
IIF6.1%
IIF typical patterns— not stated in the abstract
IIF + CLIA— not stated in the abstract
NPV
IIF99.9%
IIF typical patterns— not stated in the abstract
IIF + CLIA— not stated in the abstract
— not stated in the abstract
Further findings
- IIF positivity and patterns
- 12.7% · 653 events
- IIF positivity and patterns — CLIA negative in A-ANCA
- 97.3%
ANCA-associated vasculitis (AAV) diagnosed, with positive IIF
- AAV diagnosed (patients)
- 47
- AAV with positive IIF
- 42 (89.4%)
- Almost all AAV cases in patients with high pre-test probability (renal disease, lung infiltrates, peripheral neuropathies)
- ILD the most frequent non-AAV diagnosis in IIF-positive patients
Original publication
ANCA testing in real-world clinical practice: diagnostic performance and predictive value in a Spanish cohort. Rheumatology (Oxford). Published 6 February 2026. doi:10.
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