AUTHOR=Reiber Hansotto 

TITLE=Disease-related data patterns in cerebrospinal fluid diagnostics: medical quality versus analytical quantity

JOURNAL=Frontiers in Molecular Biosciences

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/molecular-biosciences/articles/10.3389/fmolb.2024.1348091

DOI=10.3389/fmolb.2024.1348091

ISSN=2296-889X

ABSTRACT=CSF diagnostics is characterised by the biologically relevant combination of analytes in order to obtain disease-related data patterns that enable medically relevant interpretations. The necessary change in knowledge bases such as barrier function as a diffusion/ CSF flow model and immunological networks of B cell clones and pleiotropic cytokines are considered. The biophysical and biological principles for data combination will be demonstrated using examples from neuroimmunological and dementia diagnostics. In contrast to current developments in clinical chemistry and laboratory medicine, CSF diagnostics is pointing away from mega-automated systems with a constantly growing number of individual analyses towards a CSF report that integrates all patient data. Medical training in data sample interpretation in the interlaboratory test systems ("EQA schemes") has become increasingly important. However, the results for CSF diagnostics ( EQAS from INSTAND) indicate a crucially misguided trend. The separate analysis of CSF and serum in different, non-matched assays and extreme batch variations systematically lead to misinterpretations, which are in the responsibility of the test providers. The questionable role of expensive accreditation procedures and the associated false quality expectations are discussed. 
New concepts that reintegrate the medical expertise of the clinical chemist must be emphasised, with the positive side effect of reducing costs in the healthcare system.