A Cohort Study of Free Light Chain Ratio in Combination with Serum Protein Electrophoresis as a First-Line Test in General Practice
Multiple Myeloma (MM) often present with unspecific symptoms, which can lead to diagnostic delay. Serum-free light chain (sFLC) ratio is suggested to replace urine protein electrophoresis (UPE) in the diagnostic work-up of myeloma. We aimed to investigate the performance of the sFLC-ratio in general...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/12/2930 |
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| author | Birgitte Sandfeld-Paulsen Ninna Aggerholm-Pedersen Mie Hessellund Samson Holger Jon Møller |
| author_facet | Birgitte Sandfeld-Paulsen Ninna Aggerholm-Pedersen Mie Hessellund Samson Holger Jon Møller |
| author_sort | Birgitte Sandfeld-Paulsen |
| collection | DOAJ |
| description | Multiple Myeloma (MM) often present with unspecific symptoms, which can lead to diagnostic delay. Serum-free light chain (sFLC) ratio is suggested to replace urine protein electrophoresis (UPE) in the diagnostic work-up of myeloma. We aimed to investigate the performance of the sFLC-ratio in general practice (GP) compared to UPE, just as we explored different sFLC-ratio cut-offs’ influence on diagnostic values. In a cohort of 13,210 patients from GP measures of sFLC-ratio, serum protein electrophoresis (SPE), or UPE were compared to diagnoses of incident M-component related diseases acquired from Danish health registers. UPE and sFLC-ratio equally improved diagnostic values when combined with SPE (sensitivity: SPE and UPE: 95.6 (90.6–98.4); SPE and sFLC-ratio: 95.1 (90.2–98.0)). The addition of the sFLC-ratio to SPE resulted in the identification of 13 patients with MGUS, light chain disease and amyloidosis, which was in line with the addition of UPE to SPE. The number of false-positive tests was UPE and SPE: 364 (11%) and sFLC-ratio and SPE: 677(19%). Expanding sFLC-ratio reference range to 0.26–4.32 resulted in a significant reduction in false positives <i>n</i> = 226 (6%) without loss of patients with clinical plasma cell dyscrasias. sFLC-ratio improves the diagnostic value of SPE in GP. However, due to low specificity and a large number of false positives, expanded cut-off values should be considered. |
| first_indexed | 2024-03-10T00:12:44Z |
| format | Article |
| id | doaj.art-16da9835a80c40eb9521451c90811263 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T00:12:44Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-16da9835a80c40eb9521451c908112632023-11-23T15:56:40ZengMDPI AGCancers2072-66942022-06-011412293010.3390/cancers14122930A Cohort Study of Free Light Chain Ratio in Combination with Serum Protein Electrophoresis as a First-Line Test in General PracticeBirgitte Sandfeld-Paulsen0Ninna Aggerholm-Pedersen1Mie Hessellund Samson2Holger Jon Møller3Department of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus, DenmarkDepartment of Oncology, Aarhus University Hospital, 8200 Aarhus, DenmarkDepartment of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus, DenmarkDepartment of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus, DenmarkMultiple Myeloma (MM) often present with unspecific symptoms, which can lead to diagnostic delay. Serum-free light chain (sFLC) ratio is suggested to replace urine protein electrophoresis (UPE) in the diagnostic work-up of myeloma. We aimed to investigate the performance of the sFLC-ratio in general practice (GP) compared to UPE, just as we explored different sFLC-ratio cut-offs’ influence on diagnostic values. In a cohort of 13,210 patients from GP measures of sFLC-ratio, serum protein electrophoresis (SPE), or UPE were compared to diagnoses of incident M-component related diseases acquired from Danish health registers. UPE and sFLC-ratio equally improved diagnostic values when combined with SPE (sensitivity: SPE and UPE: 95.6 (90.6–98.4); SPE and sFLC-ratio: 95.1 (90.2–98.0)). The addition of the sFLC-ratio to SPE resulted in the identification of 13 patients with MGUS, light chain disease and amyloidosis, which was in line with the addition of UPE to SPE. The number of false-positive tests was UPE and SPE: 364 (11%) and sFLC-ratio and SPE: 677(19%). Expanding sFLC-ratio reference range to 0.26–4.32 resulted in a significant reduction in false positives <i>n</i> = 226 (6%) without loss of patients with clinical plasma cell dyscrasias. sFLC-ratio improves the diagnostic value of SPE in GP. However, due to low specificity and a large number of false positives, expanded cut-off values should be considered.https://www.mdpi.com/2072-6694/14/12/2930serum-free light chain (sFLC) ratioMultiple Myelomageneral practicediagnostic work-up |
| spellingShingle | Birgitte Sandfeld-Paulsen Ninna Aggerholm-Pedersen Mie Hessellund Samson Holger Jon Møller A Cohort Study of Free Light Chain Ratio in Combination with Serum Protein Electrophoresis as a First-Line Test in General Practice Cancers serum-free light chain (sFLC) ratio Multiple Myeloma general practice diagnostic work-up |
| title | A Cohort Study of Free Light Chain Ratio in Combination with Serum Protein Electrophoresis as a First-Line Test in General Practice |
| title_full | A Cohort Study of Free Light Chain Ratio in Combination with Serum Protein Electrophoresis as a First-Line Test in General Practice |
| title_fullStr | A Cohort Study of Free Light Chain Ratio in Combination with Serum Protein Electrophoresis as a First-Line Test in General Practice |
| title_full_unstemmed | A Cohort Study of Free Light Chain Ratio in Combination with Serum Protein Electrophoresis as a First-Line Test in General Practice |
| title_short | A Cohort Study of Free Light Chain Ratio in Combination with Serum Protein Electrophoresis as a First-Line Test in General Practice |
| title_sort | cohort study of free light chain ratio in combination with serum protein electrophoresis as a first line test in general practice |
| topic | serum-free light chain (sFLC) ratio Multiple Myeloma general practice diagnostic work-up |
| url | https://www.mdpi.com/2072-6694/14/12/2930 |
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