Cerebrospinal fluid myelin basic protein is frequently ordered but has little value: a test utilization study.
Diagnosis of multiple sclerosis (MS) is facilitated by analyzing biochemical properties of cerebrospinal fluid (CSF). Oligoclonal bands (OCBs) and immunoglobulin G (IgG) index are well-established markers for evaluating patients suspected of having MS. Myelin basic protein (MBP) is also ordered frequently, but its usefulness remains questionable. OCB, IgG index, and MBP were measured in 16,690 consecutive CSF samples. Samples were divided into 2 groups based on MS status known (n = 71) or unknown (n = 16,118). Medical charts of the MS status known group were reviewed to determine their MS status. OCBs have a stronger association to IgG index results than does MBP. Importantly, MBP does not add a statistically significant increase in diagnostic sensitivity or specificity when used in combination with OCB and/or IgG index. The data indicate that MBP is an unnecessary and overused test.
The Permanente Medical Group Regional Laboratories, Berkeley, CA, USA.
Dina N
DN
Greene
Robert L
RL
Schmidt
Andrew R
AR
Wilson
Mark S
MS
Freedman
David G
DG
Grenache
D015415:Biomarkers / Q000134:cerebrospinal fluid; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D006801:Humans; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D009103:Multiple Sclerosis / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D004676:Myelin Basic Protein / Q000134:cerebrospinal fluid*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019564:Unnecessary Procedures / Q000706:statistics & numerical data
D015415:Biomarkers; D007074:Immunoglobulin G; D004676:Myelin Basic Protein