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Reevaluation of Lyme serologic quantitative test indexes: confirmation that high first-tier test index values predict
Elizabeth- Lee-Lewandrowski1,2, Kent Lewandrowski1,2
1Department of Pathology, Division of Clinical Laboratories and Molecular Medicine, Massachusetts General Hospital, Boston, MA, United States.
American Journal of Clinical Pathology
|June 8, 2026
Summary
Reporting a quantitative Lyme serologic index can eliminate the need for second-tier confirmatory testing in many cases. This improves timely diagnosis and treatment for Lyme disease.
Area of Science:
- Medical Diagnostics
- Infectious Disease Serology
Background:
- A previous study suggested a quantitative Lyme serologic index could replace second-tier testing.
- Further validation with an expanded dataset is needed to refine its clinical utility.
Purpose of the Study:
- To confirm and refine the utility of a quantitative Lyme serologic index.
- To assess its role in aiding timely clinical decisions for Lyme disease.
Main Methods:
- Reviewed one year of Lyme serologic test results using a modified 2-tier testing algorithm (MTTT).
- Determined the probability of second-tier confirmation based on the initial Lyme index value.
- Defined Lyme index brackets and constructed a predictive formula for confirmation.
Main Results:
- At the original cutoff (2.68), 98.7% of samples confirmed on second-tier testing in the expanded dataset.
- Established 6 Lyme index brackets correlating with confirmation probability.
- Developed a formula to predict second-tier confirmation across index values.
Conclusions:
- A Lyme test index value may eliminate the need for confirmatory testing on many positive first-tier samples.
- Reporting the index value and confirmation probability can improve Lyme disease diagnosis.
- This facilitates timely treatment initiation for Lyme disease.
