{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:56:39Z","timestamp":1760057799681,"version":"build-2065373602"},"reference-count":57,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Bence Jones proteins (BJPs) are monoclonal immunoglobulin free light chains (FLCs) that appear in the urine of patients with plasma cell disorders, including multiple myeloma (MM), Waldenstr\u00f6m\u2019s macroglobulinemia (WM), or light chain amyloidosis (AL). Their presence can provide valuable information about disease progression and treatment efficacy. These proteins are typically detected through a 24-h urine collection, as recommended by clinical guidelines. However, this method can be inconvenient for both patients and laboratory personnel due to its time-consuming nature and the potential for collection errors. We propose an algorithm based on serum FLC (sFLC) to rule out the presence of BJPs and diminish the need for urine testing. Methods: A retrospective data analysis of 268 serum and urine samples from 44 patients with MM was performed, and cutoffs were established to predict BJP absence: total urine protein (0.115 g\/L), sFLC \u03ba\/\u03bb ratio (&gt;0.82 \u03bb monoclonality and &lt;1.99 \u03ba monoclonality), and difference of involved\u2013uninvolved FLC (dFLC; &lt;11.93 mg\/L). A subsequent algorithm validation was performed in 716 samples from patients who underwent the same testing in routine 2023 other laboratory activity. Results: The validation of these cutoffs to rule out the presence of BJP showed that, if the protocol based on the sFLC \u03ba\/\u03bb ratio and dFLC had been applied, 42% of the urine studies would have been avoided, achieving a sensitivity of 93.9% and a false negative rate of 6.11%. Conclusions: We propose a laboratory work protocol that would allow for the avoidance of almost half of the 24-h urine studies based on sFLC measurement, a faster and more objective alternative to urine analysis for screening out the presence of BJP, with a good sensitivity and a low false negative rate.<\/jats:p>","DOI":"10.3390\/diagnostics15050525","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T06:39:07Z","timestamp":1740119947000},"page":"525","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Novel Approach to Rule-Out Unnecessary Urine Bence Jones Protein Testing: A Serum Free Light Chain Algorithm"],"prefix":"10.3390","volume":"15","author":[{"given":"Vanessa","family":"Garc\u00eda Moreira","sequence":"first","affiliation":[{"name":"Servicio de An\u00e1lisis Cl\u00ednicos, Hospital Universitario de Cabue\u00f1es, 33394 Gij\u00f3n, Asturias, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9357-3104","authenticated-orcid":false,"given":"Javier","family":"Cepeda Piorno","sequence":"additional","affiliation":[{"name":"Servicio de An\u00e1lisis Cl\u00ednicos, Hospital Universitario de Cabue\u00f1es, 33394 Gij\u00f3n, Asturias, Spain"},{"name":"Facultad de Enfermer\u00eda de Gij\u00f3n, Universidad de Oviedo, 33394 Gij\u00f3n, Asturias, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f9lia","family":"Sanders Vegara","sequence":"additional","affiliation":[{"name":"Servicio de An\u00e1lisis Cl\u00ednicos, Hospital Universitario de Cabue\u00f1es, 33394 Gij\u00f3n, Asturias, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Eyo Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Servicio de Bioqu\u00edmica Cl\u00ednica, Hospital Universitario San Agust\u00edn, 33401 Avil\u00e9s, Asturias, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Alberdi Garc\u00eda del Castillo","sequence":"additional","affiliation":[{"name":"Servicio de An\u00e1lisis Cl\u00ednicos, Hospital Universitario de Cabue\u00f1es, 33394 Gij\u00f3n, Asturias, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Gonz\u00e1lez Garc\u00eda","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad de Oviedo, 33006 Oviedo, Asturias, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nana","family":"Vaktangova","sequence":"additional","affiliation":[{"name":"Servicio de An\u00e1lisis Cl\u00ednicos, Hospital Universitario de Cabue\u00f1es, 33394 Gij\u00f3n, Asturias, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5825-6629","authenticated-orcid":false,"given":"Sandra","family":"Garc\u00eda Casta\u00f1\u00f3n","sequence":"additional","affiliation":[{"name":"Servicio de Bioqu\u00edmica Cl\u00ednica, Hospital Universitario Miguel Servet, 50009 Zaragoza, Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Al Kassam Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Servicio de An\u00e1lisis Cl\u00ednicos, Hospital Universitario de Cabue\u00f1es, 33394 Gij\u00f3n, Asturias, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"Ch\u00e1vez Collazos","sequence":"additional","affiliation":[{"name":"Servicio de Hematolog\u00eda, Hospital Universitario de Cabue\u00f1es, 33394 Gij\u00f3n, Asturias, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Gonz\u00e1lez Garc\u00eda","sequence":"additional","affiliation":[{"name":"Facultad de Enfermer\u00eda de Gij\u00f3n, Universidad de Oviedo, 33394 Gij\u00f3n, Asturias, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain"},{"name":"Servicio de Hematolog\u00eda, Hospital Universitario de Cabue\u00f1es, 33394 Gij\u00f3n, Asturias, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.annonc.2020.11.014","article-title":"Multiple Myeloma: EHA-ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up\u2020","volume":"32","author":"Dimopoulos","year":"2021","journal-title":"Ann. 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