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Variability, predictive value, and uses of the beryllium blood lymphocyte proliferation test (BLPT): preliminary
D C Deubner1, M Goodman, J Iannuzzi
1Brush Wellman Inc., Elmore, Ohio, USA.
Insights
The beryllium blood lymphocyte proliferation test (BLPT) shows fair to moderate agreement within and between major laboratories. This variability impacts its reliability for diagnosing chronic beryllium disease (CBD).
Area of Science:
- Immunotoxicology
- Occupational Medicine
- Clinical Pathology
Background:
- The beryllium blood lymphocyte proliferation test (BLPT) is a key surveillance tool for chronic beryllium disease (CBD).
- Accurate BLPT performance is crucial for identifying individuals at risk of developing CBD.
Purpose of the Study:
- To evaluate the intra- and inter-laboratory agreement of the BLPT.
- To assess the positive predictive value (PPV) of BLPT results for diagnosing CBD.
Main Methods:
- Analysis of 5483 BLPT records from 3081 samples across three laboratories (A, B, C).
- Intra-laboratory agreement assessed using split specimens tested by the same lab.
- Inter-laboratory agreement assessed by comparing results from different labs on identical samples.
- Agreement quantified using kappa statistics; PPV compared against bronchoscopy results.
Main Results:
- Intra-laboratory agreement ranged from fair to moderate (kappa 0.3-0.6).
- Inter-laboratory agreement varied: moderate between A/B (kappa 0.5) and B/C (kappa 0.6), but poor between A/C (kappa 0.2).
- Positive predictive values for CBD ranged from 39% (single abnormal test) to 49% (first-time double abnormal test).
Conclusions:
- Significant disagreement exists in BLPT results both within and between major testing laboratories.
- This variability raises concerns about the BLPT's current reliability as a sole diagnostic or surveillance tool for CBD.
- Further standardization and validation are needed to improve BLPT accuracy and clinical utility.
Abstract:
The beryllium blood lymphocyte proliferation test (BLPT) is used as a medical surveillance tool for assessment of persons at risk for developing clinical and subclinical chronic beryllium disease (CBD). Three laboratories, coded "A," "B," and "C," were used to perform the BLPTs, which involved two simultaneous tests on a split specimen. The intra-laboratory agreement analysis compared the first and the second test performed by the same laboratory. The interlaboratory agreement analysis compared test results performed by different laboratories on the same sample. The level of agreement was expressed as a kappa statistic. The positive predictive value (PPV) analysis compared BLPT results against the results of a bronchoscopy used to detect CBD. The data included 5483 records representing 3081 samples from 1510 persons. Intra-laboratory agreement was fair to moderate, with kappa values between 0.3 and 0.6. Inter-laboratory agreement was moderate (kappa = 0.5) for Labs A and B, moderate (kappa = 0.6) for Labs B and C, and poor (kappa = 0.2) for Labs A and C. A single unconfirmed abnormal test had a PPV for CBD of 39 percent, a confirmed (based on subsequent testing) abnormal test had a PPV for CBD of 45 percent, and a first-time double abnormal test had a PPV for CBD of 49 percent. Substantial inter- and intralaboratory disagreement exists between and within major laboratories that conduct this test.
