Journal article
Serum protein electrophoresis in the evaluation of lytic bone lesions
The Iowa orthopaedic journal, Vol.33, pp.114-118
2013
PMCID: PMC3748865
PMID: 24027470
Appears in Diamond Open Access
Abstract
Serum protein electrophoresis (SPEP) is often obtained at the initial evaluation of a radiolucent bone lesion of unknown etiology. The results are considered convincing evidence of the presence or absence of a plasma cell neoplasm. The sensitivity and specificity of the SPEP have not been reported in this clinical scenario. Our purpose is to assess the diagnostic value of the SPEP in the initial work-up of the radiolucent bone lesion. We identified 182 patients undergoing evaluation of a radiolucent bone lesion that included tissue biopsy and an SPEP value. We then calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SPEP as a diagnostic test for a plasma cell neoplasm in this clinical scenario. Forty-six of 182 (25.3%) patients in our series were diagnosed with a plasma cell neoplasm by histopathologic analysis. The sensitivity of SPEP was 71% and the specificity was 83%. PPV was 47% and NPV was 94%. When analyzing only those presenting with multiple lesions, the percentage of patients diagnosed with multiple myeloma increased to 44.7% (34 of 76 patients). The SPEP, however, did not have a substantially increased diagnostic accuracy with sensitivity of 71%, specificity 79%, PPV 40% and NPV 93%. SPEP lacks sensitivity and positive predictive value to provide a definitive diagnosis of myeloma in radiolucent bone lesions, but has a high negative predictive value which may make it useful in ruling out the disease. We recommend that this test either be performed in conjunction with urine electrophoresis, immunofixation electro-phoresis and free light chain assay, or after biopsy confirming the diagnosis of myeloma.
Details
- Title: Subtitle
- Serum protein electrophoresis in the evaluation of lytic bone lesions
- Creators
- Lukas M Nystrom - University of Iowa Hospitals & ClinicsDepartment of Orthopaedics & Rehabilitation , 200 Hawkins DriveIowa City , IA 52242Joseph A Buckwalter - University of Iowa, Orthopedics and RehabilitationSergei Syrbu - University of Iowa, PathologyBenjamin J Miller - University of Iowa, Orthopedics and Rehabilitation
- Resource Type
- Journal article
- Publication Details
- The Iowa orthopaedic journal, Vol.33, pp.114-118
- PMID
- 24027470
- PMCID
- PMC3748865
- NLM abbreviation
- Iowa Orthop J
- ISSN
- 1541-5457
- eISSN
- 1555-1377
- Publisher
- Dept. of Orthopaedics, The University of Iowa; United States
- Language
- English
- Date published
- 2013
- Academic Unit
- Stead Family Department of Pediatrics; Pathology; Orthopedics and Rehabilitation; Injury Prevention Research Center
- Record Identifier
- 9984053599802771
Metrics
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