{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T23:58:53Z","timestamp":1780876733338,"version":"3.54.1"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In a previous study, we reported that using a first-tier quantitative Lyme serologic index may obviate the need for second-tier confirmatory testing in samples above a defined cutoff value. Here we have expanded on the sample size to confirm and better refine the potential utility of the serologic index to aid in timely clinical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We reviewed 1 year of Lyme serologic test results sent to our laboratory for testing using a modified 2-tier testing algorithm (MTTT) to determine the probability of second-tier confirmation based on the initial Lyme index value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Using the original Lyme index cutoff at which 100% of samples confirmed on second-tier testing (2.68), in the expanded dataset, 98.7% of samples confirmed at this cutoff. Using all of the expanded sample set data, we defined 6 Lyme index brackets from highly positive to equivocal to estimate the probability of the first-tier test confirming on second-tier testing. We also constructed a formula relating the index to the probability of confirmation across the continuum of index values to predict second-tier confirmation in an MTTT algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The use of a Lyme test index value may eliminate the need for confirmatory testing on many positive first-tier samples in patients suspected of having Lyme disease. First-tier Lyme test results may be improved by reporting the index value along with the probability of confirmation. This may facilitate more timely diagnosis and clinical decision-making and potentially improve the time to antimicrobial therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajcp\/aqag051","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:33:27Z","timestamp":1776771207000},"source":"Crossref","is-referenced-by-count":0,"title":["Reevaluation of Lyme serologic quantitative test indexes: confirmation that high first-tier test index values predict a positive second-tier result in a modified 2-tier Lyme testing algorithm"],"prefix":"10.1093","volume":"165","author":[{"given":"Elizabeth-","family":"Lee-Lewandrowski","sequence":"first","affiliation":[{"name":"Department of Pathology, Division of Clinical Laboratories and Molecular Medicine, Massachusetts General Hospital , Boston, MA,","place":["United States"]},{"name":"Department of Pathology, Division of Clinical Laboratories and Molecular Medicine, Harvard Medical School , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kent","family":"Lewandrowski","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Clinical Laboratories and Molecular Medicine, Massachusetts General Hospital , Boston, MA,","place":["United States"]},{"name":"Department of Pathology, Division of Clinical Laboratories and Molecular Medicine, Harvard Medical School , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"2026060719352422100_aqag051-B1","doi-asserted-by":"crossref","first-page":"16090","DOI":"10.1038\/nrdp.2016.90","article-title":"Lyme borreliosis","volume":"2","author":"Steere","year":"2016","journal-title":"Nat Rev Dis 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predict positive second-tier result in standard and modified 2-tier Lyme testing algorithms","volume":"163","author":"Lewandrowski","year":"2025","journal-title":"Am J Clin Pathol"},{"key":"2026060719352422100_aqag051-B12","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1097\/INF.0000000000000858","article-title":"The positive predictive value of Lyme ELISA for the diagnosis of Lyme disease in children","volume":"34","author":"Lipsett","year":"2015","journal-title":"Pediatr Infect Dis J"},{"key":"2026060719352422100_aqag051-B13","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.diagmicrobio.2018.12.001","article-title":"Higher C6 immunoassay index values correlate with a diagnosis on noncutaneous Lyme disease","volume":"94","author":"Nigrovic","year":"2019","journal-title":"Diagn Microbiol Infect Dis"}],"container-title":["American Journal of Clinical 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