比较多发性骨髓瘤的五种诊断标准：227例回顾性研究。

Comparing five diagnostic criteria for multiple myeloma: a retrospective study of 227 cases.

作者信息

Junxun Li, Juan Li, Xiuzhen Tong, Juan Ouyang, Bohuang Zeng, Junru Liu

出版信息

Tumori. 2014 Mar-Apr;100(2):207-13. doi: 10.1177/030089161410000215.

DOI:10.1177/030089161410000215

PMID:24852867

Abstract

AIMS AND BACKGROUND

Several diagnostic criteria for multiple myeloma are used in clinical practice, and it can be difficult to reach a diagnosis when a patient's clinical presentation is consistent with one criterion but not with another. However, no study to date has compared the superiority of the different diagnostic criteria. The aim of this research is to compare the efficacy of five diagnostic criteria for multiple myeloma and to find the reasons for misdiagnosis of atypical multiple myeloma cases.

METHODS AND STUDY DESIGN

A total of 227 multiple myeloma cases were retrospectively studied. The clinical data (including plasma cell morphology, flow cytometry, immunofixation electrophoresis, imaging information and clinical manifestations) were scrutinized and the reasons underlying the misdiagnoses analyzed.

RESULTS

The Traditional Domestic criteria had the highest misdiagnosis rate due to the high fixed bone marrow plasma cell percentage and serum M-protein thresholds. The WHO criteria and the International Myeloma Working Group 2009 criteria exhibited relatively low misdiagnosis rates due to their lower bone marrow plasma cell percentage thresholds, flexible criteria and detailed end-organ damage descriptions. The 2003 International Myeloma Working Group criteria and the 2011 Chinese Myeloma Working Group criteria exhibited perfect performance, as each focused on monoclonal plasma cell proliferation and not on fixed bone marrow plasma cell percentage and serum M-protein thresholds.

CONCLUSIONS

The 2003 International Myeloma Working Group criteria and the 2011 Chinese Myeloma Working Group criteria have advantages in diagnosing early or atypical multiple myeloma cases. To avoid misdiagnosing some atypical cases of multiple myeloma, attention should be paid to evidence of monoclonal plasma cell proliferation, and flow cytometry may be a useful tool for discovering monoclonal plasma cell proliferation. Advanced imaging techniques should be used to confirm any suspected or atypical findings on metastatic bone survey.

摘要

目的与背景

临床实践中使用多种多发性骨髓瘤的诊断标准，当患者临床表现符合一种标准而不符合另一种标准时，可能难以做出诊断。然而，迄今为止尚无研究比较不同诊断标准的优越性。本研究的目的是比较多发性骨髓瘤五种诊断标准的有效性，并找出非典型多发性骨髓瘤病例误诊的原因。

方法与研究设计

对227例多发性骨髓瘤病例进行回顾性研究。仔细审查临床数据（包括浆细胞形态、流式细胞术、免疫固定电泳、影像信息和临床表现），并分析误诊的原因。

结果

由于骨髓浆细胞百分比固定值和血清M蛋白阈值较高，国内传统标准误诊率最高。世界卫生组织（WHO）标准和国际骨髓瘤工作组2009年标准误诊率相对较低，因为它们的骨髓浆细胞百分比阈值较低、标准灵活且对终末器官损害描述详细。2003年国际骨髓瘤工作组标准和2011年中国骨髓瘤工作组标准表现出色，因为它们都侧重于单克隆浆细胞增殖，而不是骨髓浆细胞百分比固定值和血清M蛋白阈值。