{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:07:30Z","timestamp":1788977250055,"version":"build-2803163510"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In 2017 a new consensus for antineutrophil cytoplasmic antibody (ANCA) testing was published, based on data from tertiary referral centres for ANCA-associated vasculitis (AAV). AAV-prevalence in their tested population was relatively high. We analysed how the consensus approach performs in a large teaching hospital and tailored it to secondary care settings with lower patient prevalences in their population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients screened for ANCA between 2012\u20132023 were included; clinical data were retrospectively collected. Indirect immunofluorescence (IIF) was performed using EUROPLUS\n                      <jats:sup>TM<\/jats:sup>\n                      Granulocyte Mosaic 25 IIF. MPO\/PR3 was detected by ImmunoCAP\u00ae250. Statistical analyses were performed in\n                      <jats:italic>R.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>286\/5518 (5.2%) patients tested for ANCA were positive: 63% had no AAV. Non-AAV patients often had other autoimmune diseases, malignancies, infections or used specific drugs. IIF and ELISA as first test showed good negative predictive values. ELISA as first test showed higher positive predictive value and specificity; performing a second test increased specificity. ANCA concentrations were higher in AAV than non-AAV, but ranges were wide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The majority of ANCA-positive patients did not have AAV. In our secondary care setting, ELISA performs best as first test to\n                      <jats:italic>rule out<\/jats:italic>\n                      and to\n                      <jats:italic>rule in<\/jats:italic>\n                      AAV. A second test should be considered with high clinical suspicion and a negative first test, or with low antibody concentrations, following the consensus. Additionally, we propose a second test when there is clinical doubt and a positive first test. This increases specificity and PPV, reducing false positives, which is especially relevant in secondary care settings.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0357495","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:27:41Z","timestamp":1788974861000},"page":"e0357495","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["ANCA testing strategies: A single centre experience over the past decade in a large teaching hospital in the Netherlands"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7121-0046","authenticated-orcid":true,"given":"Maria A. C.","family":"Wester Trejo","sequence":"first","affiliation":[{"name":"Leiden University Medical Center","place":["Leiden, The Netherlands"],"department":["Department of Pathology"]},{"name":"Pathology Laboratory, Pathan B.V.","place":["Rotterdam, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2834-5727","authenticated-orcid":true,"given":"Tjallingius Martijn","family":"Kuijper","sequence":"additional","affiliation":[{"name":"Maasstad Hospital","place":["Rotterdam, The Netherlands"],"department":["Department of Rheumatology and Clinical Immunology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geeke J.","family":"Waverijn","sequence":"additional","affiliation":[{"name":"Business Intelligence, Maasstad Hospital","place":["Rotterdam, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingeborg M.","family":"Bajema","sequence":"additional","affiliation":[{"name":"University Medical Center Groningen","place":["Groningen, The Netherlands"],"department":["Department of Pathology and Medical Biology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9 M. A.","family":"van den Dorpel","sequence":"additional","affiliation":[{"name":"Maasstad Hospital","place":["Rotterdam, The Netherlands"],"department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc R.","family":"Kok","sequence":"additional","affiliation":[{"name":"Maasstad Hospital","place":["Rotterdam, The Netherlands"],"department":["Department of Rheumatology and Clinical Immunology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris J. A. M.","family":"Verberk-Jonkers","sequence":"additional","affiliation":[{"name":"Maasstad Hospital","place":["Rotterdam, The Netherlands"],"department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Els J. M.","family":"Zirkzee","sequence":"additional","affiliation":[{"name":"Maasstad Hospital","place":["Rotterdam, The Netherlands"],"department":["Department of Rheumatology and Clinical Immunology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Snjezana","family":"Kos","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Chemistry, MaasstadLab, Maasstad Hospital","place":["Rotterdam, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7500-9753","authenticated-orcid":true,"given":"Annelies E.","family":"Berden","sequence":"additional","affiliation":[{"name":"Maasstad Hospital","place":["Rotterdam, The Netherlands"],"department":["Department of Rheumatology and Clinical Immunology"]},{"name":"Leiden University Medical Center","place":["Leiden, The Netherlands"],"department":["Department of Rheumatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"issue":"10","key":"pone.0357495.ref001","doi-asserted-by":"crossref","first-page":"3452","DOI":"10.1002\/art.34562","article-title":"Classification of antineutrophil cytoplasmic autoantibody vasculitides: the role of antineutrophil cytoplasmic autoantibody specificity for myeloperoxidase or proteinase 3 in disease recognition and prognosis","volume":"64","author":"S Lionaki","year":"2012","journal-title":"Arthritis Rheum"},{"issue":"1","key":"pone.0357495.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/art.37715","article-title":"2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides","volume":"65","author":"JC Jennette","year":"2013","journal-title":"Arthritis Rheum"},{"issue":"9","key":"pone.0357495.ref003","doi-asserted-by":"crossref","first-page":"102618","DOI":"10.1016\/j.autrev.2020.102618","article-title":"2020 international consensus on ANCA testing beyond systemic vasculitis","volume":"19","author":"S Moiseev","year":"2020","journal-title":"Autoimmun Rev"},{"issue":"6","key":"pone.0357495.ref004","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1177\/09612033241240588","article-title":"ANCA in patients with systemic lupus erythematosus. 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