Laboratory performance on reporting monoclonal gammopathy during cerebrospinal fluid oligoclonal banding analysis

Abstract Objective Cerebrospinal fluid (CSF) oligoclonal banding (OCB) analysis is a sensitive test used to mainly aid multiple sclerosis (MS) diagnosis. Monoclonal gammopathy is usually an incidental finding during CSF OCB analysis. The aim of this study was to assess laboratory performance on reporting monoclonal gammopathy pattern during CSF OCB analysis based on external quality assessment surveys. Methods The CSF OCB surveys from the College of American Pathologists (CAP) from 2010 to 2015 were reviewed. The UK National External Quality Assessment Service (NEQAS) CSF OCB surveys from 2014 to 2017 were also reviewed. All monoclonal gammopathy patterns were confirmed by serum protein electrophoresis followed by immunofixation on a Sebia Hydrasys analyzer. Results There were 11 monoclonal gammopathy cases identified in the CAP OCB survey from 2010 to 2015. The average rate of CAP participants that correctly reported the pattern was 25.1% (range, 2.4%–66.7%). The most common pattern incorrectly reported was the systemic inflammation pattern, followed by the oligoclonal bands present/positive pattern. The NEQAS OCB survey from 2014 to 2017 had 4 monoclonal gammopathy cases and indicated a much higher number (average, 88.5%; range, 84.1%–90.8%) of participating laboratories to successfully detect monoclonal gammopathy. Conclusion Monoclonal gammopathy is still an underrecognized pattern in the CSF OCB analysis by the CAP participating laboratories and warrants further education.

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Differentiating patterns of oligoclonal banding in the cerebrospinal fluid improves diagnostic utility for multiple sclerosis

Pathology ◽

10.1097/pat.0b013e3283511a87 ◽

2012 ◽

Vol 44 (3) ◽

pp. 248-250 ◽

Cited By ~ 6

Author(s):

Ming-Wei Lin ◽

Dan Suan ◽

Kerry Lenton ◽

Tony Henniker ◽

Therese Burke ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cerebrospinal Fluid ◽

Diagnostic Utility ◽

Oligoclonal Banding

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Interpretation of cerebrospinal fluid protein assays in various neurologic diseases.

Clinical Chemistry ◽

10.1093/clinchem/29.6.1028 ◽

1983 ◽

Vol 29 (6) ◽

pp. 1028-1030 ◽

Cited By ~ 23

Author(s):

R H Christenson ◽

P Behlmer ◽

J F Howard ◽

J B Winfield ◽

L M Silverman

Keyword(s):

Cerebrospinal Fluid ◽

Serum Albumin ◽

Lupus Erythematosus ◽

Calculated Data ◽

Albumin Concentration ◽

Sarcoidosis Patient ◽

Igg Index ◽

Oligoclonal Banding ◽

Patient Groups ◽

Protein Assays

Abstract Albumin and immunoglobulin G (IgG) were determined in cerebrospinal fluid (CSF) and serum, and the CSF/serum albumin Index (CSF X 10(3)/serum albumin concentration ratio) and IgG Index [(CSF/serum IgG)/(CSF/serum albumin)] were calculated. Data for these indices and oligoclonal banding are described in 23 cases of multiple sclerosis (MS), 19 of systemic lupus erythematosus (SLE), eight of sarcoidosis, 48 cases of miscellaneous disease, and 25 control patients with nonspecific complaints. Of the MS, SLE, and sarcoidosis patient groups, 8.5%, 26%, and 12.5% showed an abnormally high CSF/serum albumin Index; 87%, 16%, and 0% an increased IgG Index; and 87.5%, 42% and 0% showed positive oligoclonal banding. IgG Index and oligoclonal banding results for MS patients differed significantly from the sarcoidosis (p less than .001) and SLE (p less than .05) groups. When the CSF/serum albumin Index is considered also, the control and sarcoidosis patient results differ significantly from the MS group (p less than .001 and p less than .01). A strong correlation between the IgG Index and oligoclonal banding is implicated.

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An evaluation of cerebrospinal fluid oligoclonal banding confirmed by immunofixation on agarose gel.

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.46.6.500 ◽

1983 ◽

Vol 46 (6) ◽

pp. 500-504 ◽

Cited By ~ 9

Author(s):

P M George ◽

M A Lorier ◽

I M Donaldson

Keyword(s):

Cerebrospinal Fluid ◽

Agarose Gel ◽

Oligoclonal Banding

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Cerebrospinal fluid oligoclonal banding patterns and intrathecal immunoglobulin synthesis: Data comparison from a wide patient group

Neurological Sciences and Neurophysiology ◽

10.5152/nsn.2018.10247 ◽

2018 ◽

Vol 35 (1) ◽

pp. 21-28 ◽

Cited By ~ 1

Author(s):

Asli Pinar ◽

◽

Asli Tuncer Kurne ◽

Incilay Lay ◽

Nazire Pinar Acar ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Patient Group ◽

Banding Patterns ◽

Immunoglobulin Synthesis ◽

Data Comparison ◽

Oligoclonal Banding

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Cerebrospinal fluid monoclonal gammopathy in multiple myeloma and Waldenstrom's macroglobulinemia

Neurology ◽

10.1212/wnl.33.11.1411 ◽

1983 ◽

Vol 33 (11) ◽

pp. 1411-1411 ◽

Cited By ~ 17

Author(s):

P. Hansotia ◽

K. Gani ◽

W. Friedenberg

Keyword(s):

Multiple Myeloma ◽

Cerebrospinal Fluid ◽

Monoclonal Gammopathy ◽

Waldenström’S Macroglobulinemia ◽

Waldenstrom's Macroglobulinemia ◽

Waldenstrom’S Macroglobulinemia ◽

Waldenström's Macroglobulinemia

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Oligoclonal bands in cerebrospinal fluid detected by PhastSystem isoelectric focusing

Clinical Chemistry ◽

10.1093/clinchem/36.1.123 ◽

1990 ◽

Vol 36 (1) ◽

pp. 123-125 ◽

Cited By ~ 8

Author(s):

I Wybo ◽

M Van Blerk ◽

R Malfait ◽

P Goubert ◽

F Gorus

Keyword(s):

Multiple Sclerosis ◽

Central Nervous System ◽

Cerebrospinal Fluid ◽

Isoelectric Focusing ◽

Protein Electrophoresis ◽

Oligoclonal Bands ◽

Agarose Gels ◽

Oligoclonal Banding ◽

The Central Nervous System ◽

Multiple Sclerosis Patients

Abstract Pharmacia's "PhastSystem" for semi-automated isoelectric focusing (IEF) in thin precast polyacrylamide gels (PAGE) was found to be as sensitive as high-resolution protein electrophoresis (HRPE) in agarose gels and conventional PAGE-IEF for detection of oligoclonal banding (OB) in concentrated cerebrospinal fluid (CSF) samples. Both PhastSystem IEF and HRPE revealed OB in CSF from eight of nine multiple sclerosis patients and four of 10 patients with various types of infection of the central nervous system as opposed to only two of 70 patients with miscellaneous neuropsychiatric disorders. The PhastSystem also frequently detected OB in silver-stained, unconcentrated CSF from patients with multiple sclerosis.

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Oligoclonal banding in cerebrospinal fluid assessed by electrophoresis on agarose after centrifugal sample concentration through a microconcentrator membrane.

Clinical Chemistry ◽

10.1093/clinchem/31.10.1734 ◽

1985 ◽

Vol 31 (10) ◽

pp. 1734-1736 ◽

Cited By ~ 1

Author(s):

R H Christenson ◽

M E Russell ◽

K T Gubar ◽

L M Silverman ◽

G C Ebers

Keyword(s):

Multiple Sclerosis ◽

Cerebrospinal Fluid ◽

Immunoglobulin G ◽

Oligoclonal Bands ◽

Analytical Sensitivity ◽

Silver Stain ◽

Sample Concentration ◽

Analytical Recovery ◽

Oligoclonal Banding ◽

And Control

Abstract We describe use of a microconcentrator membrane with a 30 000-Da cutoff for treatment of cerebrospinal fluid (CSF) specimens before detection of oligoclonal bands by electrophoresis on agarose. After centrifugation at 2000 X g for 25 min, 0.5-, 1.0-, and 2.0-mL aliquots of CSF were concentrated 15-, 25-, and 40-fold. Analytical recovery of immunoglobulins G and A from the microconcentrators was about 90% (CV 5-8%). We found good correlation between results by this method and by a silver-stain procedure in a study comparing oligoclonal banding in CSF from multiple sclerosis and control patients. After 40-fold concentration of 2 mL of CSF, 2 mg of immunoglobulin G per liter can be detected, because the analytical sensitivity of the electrophoresis is 80 mg/L.

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Multiple sclerosis: use of light-chain typing to assist diagnosis

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1258/0004563011900669 ◽

2001 ◽

Vol 38 (3) ◽

pp. 235-241 ◽

Cited By ~ 14

Author(s):

Margaret A Jenkins ◽

Louisa Cheng ◽

Sujiva Ratnaike

Keyword(s):

Multiple Sclerosis ◽

Cerebrospinal Fluid ◽

Oligoclonal Bands ◽

Light Chains ◽

Banding Patterns ◽

Diagnostic Use ◽

Clinical Laboratories ◽

Oligoclonal Banding ◽

Oligoclonal Igg ◽

Abnormal Ratio

Although the presence of oligoclonal IgG with abnormal ratio in multiple sclerosis (MS) has been known for many years, this finding has not been put to diagnostic use in most routine clinical laboratories. In a retrospective study we report differences in the oligoclonal banding patterns between multiple sclerosis and non-MS patients. We had sufficient cerebrospinal fluid (CSF) on 36 from 71 patients with oligoclonal bands for immunofixation for κ and λ light chains, and for free κ and free λ. Thirteen out of 14 patients with clinically confirmed MS had predominantly IgG (κ) banding. In contrast, in seven out of eight patients with diagnoses other than MS the IgG was linked to both κ and λ light chains in approximately equal proportions. Nine out of 14 patients with probable/possible/ suspected MS showed predominantly IgG (κ) banding; five others in this group had both IgG (κ) and IgG (λ) and free λ light chains. The finding of IgG (κ) bands in CSF samples with oligoclonal bands supports a diagnosis of MS.

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