Area Editoriale
BACKGROUND: Serum antinuclearantibodies giving the 'multiple nuclear dots' or the 'rim-like/membranous' patternsare frequently detected by indirect immunofluorescence on HEp-2 cells inpatients with primary biliary cirrhosis. AIM: To assess the accuracy ofmultiple nuclear dot and rim-like/membranous antinuclear antibodies for thediagnosis of primary biliary cirrhosis. METHODS: Sera from 4371 consecutivepatients referred to our laboratory were analysed under code for antinuclearantibodies testing by indirect immunofluorescence on HEp-2 cells. RESULTS:Review of the clinical records of the 4371 patients allowed identification of101 patients with antimitochondrial antibody-positive primary biliary cirrhosisand 22 with antimitochondrial antibody-negative variant. Multiple nuclear dotand/or rim-like/membranous patterns were found in 59 (1.3%) of the 4371 patients:31 antimitochondrial antibody-positive primary biliary cirrhosis, 17antimitochondrial antibody-negative primary biliary cirrhosis and 11non-primary biliary cirrhosis. The specificity for primary biliary cirrhosis ofboth the antinuclear antibodies pattern was 99%. Positive predictive value andlikelihood ratio for a positive test were 86% (95% CI: 72.7-94) and 221 (95%CI: 91.7-544) for multiple nuclear dot, 79% (95% CI: 62.2-90.1) and 132 (95%CI: 56.8-312.7) for rim-like/membranous, respectively. CONCLUSIONS: Multiplenuclear dot and rim-like/membranous antinuclear antibodies are rare findings.Their positivity strongly suggests the diagnosis of primary biliary cirrhosis,irrespective of antimitochondrial antibody status. The high specificity for primarybiliary cirrhosis makes them a useful diagnostic tool especially inantimitochondrial antibody-negative patients. Leggil'articolo