Clinical utility of Pandy test in the face of quantitative CSF total protein and albumin: A retrospective study and literature review.

Introduction: Qualitative Pandy test has long been used to indicate raised globulins in the cerebrospinal fluid (CSF). Despite its shortfalls and the availability of quantitative CSF protein assays, Pandy test continues to be performed in clinical laboratories across Malaysia.

Objectives: (1) Compare diagnostic performance of Pandy test to CSF total protein and albumin; (2) Conduct literature review on clinical utility of Pandy test.

Materials And Methods: This is a retrospective, cross-sectional study involving 890 inpatients of all ages with CSF biochemistry analysed in Hospital Pulau Pinang over a period of 7 months. Patient demographics, clinical diagnosis and CSF total protein, albumin and Pandy results were collected and analysed using Mann-Whitney U test, Spearman rank-order correlation coefficient, Chi Square test and receiver operating characteristic (ROC) curve analysis.

Results: CSF total protein, CSF albumin, CSF protein-albumin difference and age showed significantly higher median values in patients with positive Pandy compared to negative Pandy. Significant associations were found between positive Pandy test with clinical diagnosis (Cramers V 0.443, p<0.01), sample haemolysis (Phi 0.326, p<0.01), CSF protein-albumin difference (Spearman 0.727, p<0.001), CSF total protein (Spearman 0.710, p<0.001) and CSF albumin (Spearman 0.662, p<0.01). All three quantified CSF parameters showed comparably good sensitivity and specificity in determining positive Pandy.

Discussion And Conclusion: Good correlation with CSF proteins, analytical issues and reagent hazards indicate no added clinical value of Pandy test in the face of quantified CSF total protein and albumin. Abolishing the test saves resources, reduces occupational hazards and shortens turnaround time without compromising diagnosis.