Cerebrospinal fluid myelin basic protein is frequently ordered but has little value: a test utilization study

Area of Science:

• Neurology
• Clinical Chemistry
• Biochemistry

Background:

• Cerebrospinal fluid (CSF) analysis aids in multiple sclerosis (MS) diagnosis.
• Oligoclonal bands (OCBs) and immunoglobulin G (IgG) index are established MS biomarkers.
• The utility of myelin basic protein (MBP) in MS diagnosis is debated.

Purpose of the Study:

• To evaluate the diagnostic value of MBP in conjunction with OCBs and IgG index for MS.
• To determine if MBP enhances the sensitivity or specificity of MS diagnosis using CSF markers.

Main Methods:

• Retrospective analysis of 16,690 CSF samples.
• Measurement of OCBs, IgG index, and MBP.
• Comparison of marker performance with and without MBP, using MS status from medical records.

Main Results:

• OCBs demonstrated a stronger correlation with the IgG index than with MBP.
• MBP did not significantly improve the diagnostic sensitivity or specificity when added to OCB and/or IgG index analysis.
• The study identified MBP as an overused and unnecessary test in MS diagnostics.

Conclusions:

• OCBs and IgG index are sufficient for MS diagnosis via CSF analysis.
• MBP testing provides no additional statistically significant diagnostic benefit in the context of OCBs and IgG index.
• Clinical guidelines should reconsider the routine use of MBP for MS diagnosis.