Systematic review of errors on beta‐2 transferrin gel electrophoresis testing of rhinorrhea and otorrhea

Eide, Jacob G.; Mason, William; Ray, Amrita; Carey, John; Cook, Bernard; Craig, John R.

doi:10.1002/alr.23293

Cited by 2 publications

(1 citation statement)

References 60 publications

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“…4 , 14 This test is not perfect; the presence of B2T in the blood can be modulated in rare cases by liver and metabolic disorders, which may lead to the presence of B2T in the sinonasal tract (false positives), while certain intracranial infections can decrease B2T within CSF (false negatives). 21 Even so, sensitivity and specificity reportedly range from 87%–100% to 71%–94%, respectively. 4 , 14 , 22 …”

Section: Current Methods In Diagnosismentioning

confidence: 99%

Multimodal diagnosis of cerebrospinal fluid rhinorrhea: State of the art review and emerging concepts

Torabi,

Abiri,

Chen

et al. 2024

Laryngoscope Investig Oto

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ObjectiveCurrently, diagnosis of cerebrospinal fluid (CSF) rhinorrhea relies on a multimodal approach, increasing costs and ultimately delaying diagnosis. In the United States and internationally, the crux of such a diagnosis relies on confirmation testing (via biomarkers) and localization (e.g., imaging). Biomarker testing may require analysis at an outside facility, resulting in delays diagnosis and treatment. In addition, specialized imaging may be nonspecific and often requires an active leak for diagnosis. There remains a clear need for innovative new technology.MethodsA comprehensive review was conducted on both foundational and innovative scholarly articles regarding current and emerging diagnosis modalities for CSF.ResultsCurrent modalities in CSF rhinorrhea diagnosis and localization include laboratory tests (namely, B2T immunofixation), imaging (CT and/or MRI) with or without intrathecal administration, and surgical exploration. Each of these modalities carry flaws, risks, and benefits, ultimately contributing to delays in diagnosis and morbidity. Promising emerging technologies include lateral flow immunoassays (LFI) and biologically functionalized field‐effect transistors (BioFET). Nevertheless, these carry some drawbacks of their own, and require further validation.ConclusionCSF rhinorrhea remains a challenging diagnosis, requiring a multimodal approach to differentiate from nonpathologic causes of rhinorrhea. Current methods in diagnosis are imperfect, as the ideal test would be a readily accessible, inexpensive, rapid, highly accurate point‐of‐care test without the need for excess fluid or specialized processing. Critical work is being done to develop promising, new, improved tests, though a clear successor has not yet emerged.Level of EvidenceN/A

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Section: Current Methods In Diagnosismentioning

confidence: 99%

Multimodal diagnosis of cerebrospinal fluid rhinorrhea: State of the art review and emerging concepts

Torabi,

Abiri,

Chen

et al. 2024

Laryngoscope Investig Oto

View full text Add to dashboard Cite

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Diagnostic Accuracy of Beta‐2 Transferrin Gel Electrophoresis for Detecting Cerebrospinal Fluid Rhinorrhea

Eide,

Mason,

Mackie

et al. 2024

The Laryngoscope

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ObjectiveUnilateral thin clear rhinorrhea (UTCR) may represent a variety of pathologies including cerebrospinal fluid (CSF) rhinorrhea. Beta‐2 transferrin (B2Tf) gel electrophoresis (GE) has become the preferred testing modality due to reportedly high sensitivity (87%–100%) and specificity (71%–100%). However, there have been relatively few studies assessing its diagnostic accuracy. The purpose of this single‐institution study was to determine the accuracy of B2Tf GE in detecting CSF rhinorrhea.MethodsA single‐center retrospective review was conducted from 2016 and 2024 for all patients who presented with UTCR and underwent B2Tf GE. Institutional review board approval was obtained. The gold standard for diagnostic confirmation of true and false positives (TP, FP) as well as false negatives (FN) was endoscopic exploration. The gold standard for true negative (TN) was response to medical therapy.ResultsA total of 105 patients underwent 149 B2Tf GE tests. 40 (38.1%) patients were diagnosed with CSF rhinorrhea. Of the 149 B2‐Tf GE tests, there were 51 TPs, 72 TNs, 20 FPs, and 6 FNs yielding 89.5% sensitivity, 78.3% specificity, 71.8% positive predictive value, and 92.3% negative predictive value, respectively. Of the false results the most common causes for error were purulent sinusitis (n = 6, 23.1%), possible mucous contamination from nose‐blowing during collection (n = 3, 11.5%), patient collection error (n = 3, 11.5%), and blood contamination (n = 1, 3.8%).ConclusionAlthough these single‐institutional data demonstrate test accuracy within ranges previously reported in the literature, they also demonstrate diagnostic limitations. Future studies should explore reasons for erroneous B2Tf GE results and how these may change clinical decision‐making.Level of EvidenceIV Laryngoscope, 2024

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Systematic review of errors on beta‐2 transferrin gel electrophoresis testing of rhinorrhea and otorrhea

Cited by 2 publications

References 60 publications

Multimodal diagnosis of cerebrospinal fluid rhinorrhea: State of the art review and emerging concepts

Multimodal diagnosis of cerebrospinal fluid rhinorrhea: State of the art review and emerging concepts

Diagnostic Accuracy of Beta‐2 Transferrin Gel Electrophoresis for Detecting Cerebrospinal Fluid Rhinorrhea

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