Evaluation of the Screening Tests for the Diagnosis of Plasma Cell Neoplasm

Yusun Hwang; Wha Soon Chung; Ki-Sook Hong

doi:10.3343/lmo.2012.2.2.80

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Hwang, Chung, and Hong: Evaluation of the Screening Tests for the Diagnosis of Plasma Cell Neoplasm

Original Article

Clinical Chemistry

Laboratory Medicine Online

Laboratory Medicine Online 2012; 2(2): 80-86.

Published online: 30 March 2012

DOI: https://doi.org/10.3343/lmo.2012.2.2.80

Evaluation of the Screening Tests for the Diagnosis of Plasma Cell Neoplasm

Yusun Hwang, M.D., Wha Soon Chung, M.D., Ki-Sook Hong, M.D.

Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Ki-Sook Hong, M.D. Department of Laboratory Medicine, Seoul Seonam Hospital, Ewha Womans University Medical Center, 1320-7 Sinjung-dong, Yangcheon-gu, Seoul 158-070, Korea. Tel: +82-2-6300-7652, Fax: +82-2-6300-7660, kshong@ewha.ac.kr

Received 16 August 2011 Revised 7 November 2011 Accepted 30 November 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Plasma cell neoplasm is diagnosed by performing bone marrow examination, serum- and urine-protein electrophoresis, and quantification of free light chains of immunoglobulins. We characterized and quantified monoclonal proteins typical of different diagnosed conditions to determine the best screening test(s).

Methods

We retrospectively reviewed diagnosis of and the characteristics of monoclonal proteins from 113 patients with monoclonal gammopathy. Monoclonal proteins were detected by agarose-gel electrophoresis and capillary electrophoresis, and if the results were ambiguous, they were confirmed by immunofixation electrophoresis. Free light chains were measured using nephelometry.

Results

The concentrations of monoclonal proteins in 113 patients with different conditions were as follows: multiple myeloma (MM) (67%), 2.66 (0.87-9.48) g/dL; monoclonal gammopathy of undetermined significance (MGUS) (26%), 0.62 (0.08-2.95) g/dL; lymphoma (3%), 3.65 (1.59-6.54) g/dL; Waldenstrom's macroglobulinemia (2%), 1.99 (1.08-2.90) g/dL; amyloidosis (2%), 0.61 g/dL; and POEMS syndrome (1%), 0.99 g/dL. There was a significant difference in the concentration and κ/λ ratio (which was based on the immunetype of the monoclonal proteins) of the monoclonal proteins in patients with MM and MGUS (P<0.001 and P=0.004, respectively). The diagnostic sensitivity of serum-protein electrophoresis, free-light-chain assay, and bone marrow analysis was 87.6%, 84.1%, and 84.5%, respectively. The sensitivity of a combination of 2 or 3 of these tests was higher at 100%.

Conclusions

A combination of protein electrophoresis with immunotyping and serum free-light-chain assay may be the best screening method for detecting monoclonal proteins since its non-invasiveness.

Keywords: Plasma cell neoplasm, Monoclonal protein, Screening test

Figures and Tables

Table 1

Characterization of monoclonal proteins and ratio of free light chains according to the diagnosis

^*Individual sample results with an unquantifiable M-protein concentration were excluded; ^†Normal reference interval: 0.26-1.65; ^‡Serum-protein electrophoresis and immunoelectrophoresis showed only IgA-M protein, and the corresponding light chain was not confirmed using immunofixation electrophoresis; ^§M proteins of other six patients were too small to quantify.

Abbreviations: MM, multiple myeloma; MGUS, monoclonal gammopathy of undetermined significance; WM, Waldenstrom's macroglobulinemia; POEMS, POEMS syndrome; n, the number of cases; NT, not tested; NA, not applicable.

Table 2

Comparison of the diagnostic sensitivity of each test for different diagnosed conditions

Abbreviations: SEP, electrophoresis and immunoelectrophoresis (IEP) and/or immunofixation electrophoresis (IFE) performed on serum samples; UEP, electrophoresis and immunoelectrophoresis (IEP) and/or immunofixation electrophoresis (IFE) performed on urine samples; rFLC, ratio of free light chain; BM, bone marrow biopsy; MM, multiple myeloma; MGUS, monoclonal gammopathy of undetermined significance; WM, Waldenstrom's macroglobulinemia; POEMS, POEMS syndrome; NT, not tested; n, positive cases over the total cases in each screening tests.

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