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Test ID: MSP3 Multiple Sclerosis (MS) Profile, Serum and Spinal Fluid


Specimen Required


Both serum and spinal fluid are required. Spinal fluid must be obtained within 1 week of serum collection.

 

Specimen Type: Spinal fluid

Container/Tube: Sterile vial

Specimen Volume: 1 mL

Collection Instructions: Label specimen as spinal fluid.

 

Specimen Type: Serum

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions:

1. Centrifuge and aliquot serum into a plastic vial within 2 hours of collection.

2. Label specimen as serum.


Useful For

Diagnosing multiple sclerosis, especially helpful in patients with equivocal clinical or radiological findings

Profile Information

Test ID Reporting Name Available Separately Always Performed
KCSFP Kappa Free Light Chain, CSF Yes, (KCSF) Yes
XSRM Additional sample for reflex OLIGS No Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
OLIGS Serum Bands Yes, (Order OLIG, submit CSF and Serum) No
OLIGC CSF Bands Yes, (Order OLIG, submit CSF and Serum) No

Testing Algorithm

Kappa free light-chain testing will be performed by nephelometry on all samples. When kappa free light-chain testing indicates either borderline or positive results (≥0.0600 mg/dL), the oligoclonal banding tests will be performed at an additional charge. If the time of testing exceeds the specimen stability for oligoclonal banding tests, only kappa free light-chain testing will be performed. Kappa free light-chain testing will only be performed up to specimen stability.

Method Name

KCSFP: Nephelometry

OLIGC, OLIGS: Isoelectric Focusing (IEF) with IgG Immunoblot Detection

Reporting Name

Multiple Sclerosis Profile

Specimen Type

CSF
Serum

Specimen Minimum Volume

Serum, Spinal fluid: 0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
CSF Frozen (preferred) 14 days
  Refrigerated  72 hours
  Ambient  24 hours
Serum Frozen (preferred) 14 days
  Ambient  14 days
  Refrigerated  14 days

Clinical Information

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease characterized by visual, motor, and sensory disturbances. The diagnosis of MS is dependent on clinical, radiological, and laboratory findings. The detection of increased intrathecal immunoglobulin synthesis is the basis for current diagnostic laboratory tests for MS. These tests include the kappa free light chain detection in cerebrospinal fluid (CSF) and CSF oligoclonal band detection.

Reference Values

KAPPA FREE LIGHT CHAIN

Medical decision point: 0.1000 mg/dL

Positive: ≥0.1000 mg/dL

Borderline: 0.0600 mg/dL-0.0999 mg/dL

Negative <0.0600 mg/dL

 

OLIGOCLONAL BANDS:

<2 bands

Interpretation

When result is less than 0.0600 mg/dL, the kappa free light-chain concentration measured in cerebrospinal fluid (CSF) is lower than the threshold associated with demyelinating disease. This is a negative result. Testing for oligoclonal banding is not performed. Clinical correlation is recommended.

 

When result is between 0.0600 and 0.0999 mg/dL, this is a borderline result. These findings are not specific for multiple sclerosis (MS) because CSF-specific immunoglobulin synthesis may also be detected in patients with other neurologic diseases (infectious, inflammatory, cerebrovascular, autoimmune, and paraneoplastic). Clinical correlation is recommended. Automatic reflexing to oligoclonal bands will occur.

 

When result is 0.1000 mg/dL or more, the kappa free light chain concentration measured in CSF is at or greater than the threshold associated with demyelinating disease. This is a positive result. These findings, however, are not specific for MS because CSF-specific immunoglobulin synthesis may also be detected in patients with other neurologic diseases (infectious, inflammatory, cerebrovascular, autoimmune, and paraneoplastic). Clinical correlation is recommended. Automatic reflexing to oligoclonal bands will occur.

 

A Mayo Clinic study published in 2018 with 325 patients suggested that a kappa free light-chain concentration in CSF greater than or equal to 0.06 mg/dL has 92% clinical sensitivity for the diagnosis of MS.(1)

 

A second, larger Mayo Clinic study with 1355 patients published in 2021 showed that a kappa CSF concentration greater than or equal to 0.06 mg/dL had approximately 89% sensitivity. When kappa value was greater than or equal to 0.1 mg/dL, it had similar sensitivity (87%) to the finding of two unique CSF oligoclonal bands (89%).(2)

 

Given the difference in thresholds based on these studies and highest sensitivity at the threshold of 0.06 mg/dL, any CSF kappa free light-chain result greater than or equal to 0.06 mg/dL will reflex to oligoclonal banding when the multiple sclerosis profile test is ordered.

 

When the oligoclonal band assay detects 2 or more unique IgG bands in the CSF, the result is positive.

 

CSF is used in the diagnosis of MS by identifying increased intrathecal IgG synthesis qualitatively (oligoclonal bands). The presence of 2 or more unique CSF oligoclonal bands was reintroduced as one of the diagnostic criteria for MS in the 2017 revised McDonald criteria. These findings, however, are not specific for MS as CSF-specific IgG synthesis may also be found in patients with other neurologic diseases including infectious, inflammatory, cerebrovascular, and paraneoplastic disorders. Clinical correlation is recommended.

Clinical Reference

1. McGinley MP, Goldschmidt CH, Rae-Grant AD: Diagnosis and treatment of multiple sclerosis: A review. JAMA. 2021 Feb 23;325(8):765-779. doi: 10.1001/jama.2020.26858

2. Hegen H, Walde J, Milosavljevic D, et al: Free light chains in the cerebrospinal fluid. Comparison of different methods to determine intrathecal synthesis. Clin Chem Lab Med. 2019 Sep 25;57(10):1574-1586. doi: 10.1515/cclm-2018-1300

3. Thompson AJ, Banwell BL, Barkhof F, et al: Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018 Feb;17(2):162-173

4. Gurtner KM, Shosha E, Bryant SC, et al: CSF free light chain identification of demyelinating disease: comparison with oligoclonal banding and other CSF indexes. Clin Chem Lab Med. 2018;56:1071-1080

5. Saadeh RS, Bryant SC, McKeon A, et al: CSF kappa free light chains: cutoff validation for diagnosing multiple sclerosis. Mayo Clin Proc. 2022 Apr;97(4):738-751. doi: 10.1016/j.mayocp.2021.09.014

6. Hegen H, Zinganell A, Auer M, Deisenhammer F: The clinical significance of single or double bands in cerebrospinal fluid isoelectric focusing. A retrospective study and systematic review. PLoS One. 2019 Apr 15;14(4):e0215410. doi: 10.1371/journal.pone.0215410

7. Deisenhammer F, Zetterberg H, Fitzner B, Zettl UK: The Cerebrospinal fluid in multiple sclerosis. Front Immunol. 2019 Apr 12;10:726. doi: 10.3389/fimmu.2019.00726

8. Susse M, Hannich M, Petersmann A, et al: Kappa free light chains in cerebrospinal fluid to identify patients with oligoclonal bands. Eur J Neurol. Sep 2018;25(9):1134-1139. doi: 10.1111/ene.13667

Day(s) Performed

Monday through Friday

Report Available

3 to 5 days

Test Classification

This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

83521

83916 x2 (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
MSP3 Multiple Sclerosis Profile 100757-4

 

Result ID Test Result Name Result LOINC Value
KCSFP Kappa Free Light Chain, CSF 48774-4
XSRM Additional sample for Reflex OLIGS No LOINC Needed

Forms

If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.

Mayo Clinic Laboratories | Neurology Catalog Additional Information:

mml-Demyelinating-Diseases