AMBOSS diagnostic workup:
- Initial laboratory studies (e.g., CBC, CMP, urinalysis)
- Myeloma biomarkers (e.g., serum and urine protein electrophoresis, free light chain assay, LDH)
- Imaging to assess for bone lesions (e.g., whole-body low-dose CT scan)
I understand that this is what the initial part of amboss says (minimum diagnostic work up) and just after that it says refer them to oncologist for “diagnostic confirmation using bone marrow biopsy” so it’s not the next step, if anything it should be done before the biopsy
in the section about imaging it says that it’s the first line for bone surveillance (i know that it might be indicated for all patients, but so do SPEP and other tests) i cant see the whole body ct and marrow biopsy at the same level
From what i understand from UTD and amboss is that it’s used in newly diagnosed patients as a baseline and also in suspected “smoldering MM”
Last thing is that this card is mainly made from the UW step 3 question which says in the question that the patient was diagnosed with MM using bone marrow biopsy and no she has bone pain, what is the next step? I believe we order the CT because of her bone pain not to confirm the MM diagnosis
This was based off whatever MedicalArk used when making cards for Step 2 (I think they mainly used AMBOSS and some Step 2 UW). The idea seems to be that the presence of bone lesions on imaging is part of the diagnostic criteria for MM (you need evidence on biopsy + at least one CRAB symptom or biomarker) so card is correct as is. What if instead we change it to:
“What imaging is indicated in the initial work-up of patients with suspected plasma-cell dyscrasia?”
[+ we can clean up and shorten some bits in extra, add back need for bone marrow biopsy]
This way we’re being more explicit in that we are discussing initial work up of the case and specifying imaging > labs or biopsy.
(@herstein.jacob as well)
@AnKing-Maintainers bit of a more complicated one, see my suggestion to change card above. Card is trying to get at initial diagnostic work-up of multiple myeloma, which should include a whole-body CT
Prefer @Cameron’s version.