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Multiple Myeloma: Sensitivity and Specificity

Introduction: Multiple myeloma is a plasma cell neoplasm producing a large amount of an immunoglobulin (IgG) causing end-organ damage. In particular, the patient must meet the following 3 criteria:

  • Presence of a monoclonal protein in the serum and/or urine
  • Presence of monoclonal plasma cells in the bone marrow >10%
  • Presence of end-organ damage: hypercalcemia, renal insufficiency, anemia, or lytic bone lesions
  • Diagnosis of a monoclonal proteinopathy proceeds with SPEP, UPEP, free light chains (FLC).

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    Tags: Hematologic Neoplasm Tag this Diagnosis.

    The sensitivity and specificity of findings for Multiple Myeloma are listed below. See the left navigation bar to change the display.

    Sensitive and Specific Findings

    Finding SensitivitySpecificity Comments, Study
    SPEP and FLC Edit 100%99%

    Study: Ann Clin Lab Sci. 2006 Spring;36(2):157-62. PMID: 16682511

    Serum Free Light Chains Edit 88%98%

    Patients with k/l ratios >1.65 or <0.26 are identified as producing clonal {kappa} or {lambda} FLCs, respectively.

    Study: Ann Clin Lab Sci. 2006 Spring;36(2):157-62. PMID: 16682511

    Sensitive Findings

    Finding SensitivitySpecificity Comments, Study
    Serum Immunofixation Electrophoresis Edit Sensitivity = 93%

    specificity not assessed. For patients defined by abnormal urine immunofixation electrophoresis.

    Study: Mayo Clin Proc. 2006 Dec;81(12):1575-8. PMID: 17165636

    Proteinuria Edit Sensitivity = 88%

    specificity not assessed

    Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582

    Poorly Diagnostic Findings

    Finding SensitivitySpecificity Comments, Study
    SPEP Edit 64%81%

    aka Serum Protein Electrophoresis

    The presence of one or more distinct peaks not corresponding to the usual protein bands in the gamma or beta globulin regions indicated the possible presence of a monoclonal or polyclonal gammopathy.

    Study: Ann Clin Lab Sci. 2006 Spring;36(2):157-62. PMID: 16682511

    X-Ray Edit Sensitivity = 79%

    specificity not assessed

    Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582

    UPEP Edit Sensitivity = 75%

    globulin spike

    specificity not assessed

    Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582

    Bone Pain Edit Sensitivity = 68%

    specificity not assessed

    Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582

    Anemia Edit Sensitivity = 62%

    specificity not assessed

    Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582

    Renal Insufficiency Edit Sensitivity = 55%

    specificity not assessed

    Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582

    Bence-Jones Proteinuria Edit Sensitivity = 49%

    monoclonal light chains in urine

    specificity not assessed

    Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582

    Hypercalcemia Edit Sensitivity = 30%

    specificity not assessed

    Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582

    Palpable Liver Edit Sensitivity = 21%

    specificity not assessed

    Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582

    Hypogammaglobulinemia Edit Sensitivity = 9%

    specificity not assessed

    Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582

    Palpable Spleen Edit Sensitivity = 5%

    specificity not assessed

    Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582