ArticleJournal of clinical laboratory analysis2026
Retrospective Identification and Quantitative Image Analysis of the ICAP Nuclear Pattern AC-30 in Antinuclear Antibody Testing.
Article in Journal of clinical laboratory analysis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe International Consensus on ANA Patterns (ICAP) recently codified the AC-30 nuclear pattern, characterized by fine speckled nuclear texture and metaphase chromatin staining. Although formally recognized, its clinical significance remains unclear. Quantitative methods and objective outcome measures for characterizing AC-30 have not been established.
methodsA retrospective analysis was conducted using archived HEp-2 ANA images. AC-30 was defined by unanimous scoring from three blinded experts. AC-1 and AC-2 served as comparator sets. Clinical diagnoses and serological data were retrieved from hospital records. Pixel classification was performed using ilastik, and per-nucleus intensity features were extracted with CellProfiler. Image-level separation was assessed by partitioning nuclei into high- and low-intensity groups via Isolation Forest. Statistical comparisons used Welch's t-tests and Spearman's rank correlation.
resultsThe AC-30 group included 183 images (AC-1, n = 183; AC-2, n = 207). Within AC-30, 57.4% had non-AID or unknown diagnoses, 26.8% had other autoimmune diseases, and 15.8% had ANA-associated rheumatic disease (AARD). In ENA-negative AC-30, AARD accounted for 7.7% (6/78), compared to 18.3% (21/115) in ENA-negative AC-2. RA accounted for 16.9% (31/183) in AC-30, consistent across ENA strata. AC-30 displayed lower per-nucleus intensities than AC-2 (all p < 0.0001) and reduced per-image ΔMaxIntensity (0.177 vs. 0.252, p < 0.0001), while ΔMeanIntensity was similar (0.068 vs. 0.067, p = 0.549).
conclusionsAC-30 is quantitatively dimmer than AC-2, with reduced nuclear brightness and peak-intensity separation. In this retrospective cohort, ENA-negative AC-30 was associated with fewer AARD cases. RA accounted for ~17% of AC-30, and anti-CCP and RF remained informative markers. The ilastik-CellProfiler workflow enables auditable ANA quantification.
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