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Evaluating the Value of Tissue-Based Assays in the Diagnosis of AE
Yaxiu Fang1, Yan Tan1, Guanghui Liu2
1Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University, 510370 Guangzhou, Guangdong, China.
Background:
Tissue-based assay (TBA) results can reveal the existence of antibodies other than known antibodies. Clinically, some patients with negative cell-based assay (CBA) but positive TBA have similar symptoms to autoimmune encephalitis (AE), indicating that positive TBA results still provide a certain reference for clinicians to make decisions. Through a retrospective study, the diagnostic rate of AE in our center and the auxiliary diagnostic value of TBA for AE were analyzed. The sensitivity and specificity of cerebrospinal fluid TBA in the diagnosis of AE were also evaluated.
Methods:
Patients who met the diagnostic criteria for confirmed and possible AE in our center were retrospectively selected. The positive and negative rates of TBA in patients diagnosed with AE were analyzed, as were the positive rate and subcellular localization of TBA in possible AE patients with a negative CBA.
Results:
Among the 61 cases of confirmed AE, 48 cases had positive TBA, resulting in a detection rate of 79%. There were 13 cases (21%) with false negatives. Among the 115 possible AE patients with negative autoantibodies, 97 cases (45.8%) had positive TBA. Based on the cellular morphology revealed by staining, these cases were categorized into neuronal cell staining (48 cases, including 8 cases with membrane staining, 19 cases with nuclear staining, and 21 cases with cytoplasmic antibody), glial cell staining (15 cases), and simultaneous staining of neuronal and glial cells (4 cases); The area under the curve of AE confirmed by TBA positivity diagnosis was 0.672, 95% CI 0.594-0.749, p < 0.001, with sensitivity, specificity, and Youden's index of 78.7%, 55.6%, and 0.343, respectively. In the logistic regression model for positive TBA and elevated cerebrospinal fluid leukocyte counts, the area under the curve (AUC) was 0.728, 95% CI 0.654-0.803, p < 0.001, with sensitivity and specificity, and Youden's index of 57.4%, 79.5%, and 0.368, respectively.
Conclusions:
TBA serves as an effective complementary tool to CBA for AE diagnosis, with a sensitivity of 78.7% and specificity of 55.6%. Combining a positive TBA with an elevated cerebrospinal fluid (CSF) leukocyte count improved diagnostic specificity to 79.5%, suggesting that comprehensive evaluation integrating both assays can reduce missed diagnoses and optimize clinical management.
