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Fu W, Yue Y, Song Y, Zhang S, Shi J, Zhao R, Wang Q, Zhang R. Comparable analysis of six immunoassays for carcinoembryonic antigen detection. Heliyon 2024; 10:e25158. [PMID: 38322892 PMCID: PMC10845681 DOI: 10.1016/j.heliyon.2024.e25158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/05/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
Objective This study aimed to assess the current status of carcinoembryonic antigen (CEA) detection. We evaluated the correlation, consistency, and comparability of CEA results among six automated immunoassays, and combined with the results of CEA trueness verification of the Beijing Center for Clinical Laboratories (BCCL) for further analysis. Methods Abbott Architect i2000, Beckman DxI800, Roche Cobas E601, Diasorin Liaison XL, Maccura IS1200, and Autolumo A2000 were used to detect 40 individual serum CEA samples. Taking the optimal analytical quality specifications calculated from data on biological variation as the evaluation criterion. Passing-Bablok regression and Bland-Altman analysis were performed between each assay and all-assays median values to evaluate the correlation and relative difference. The concordance correlation coefficient (CCC) was used for consistency analysis. Additionally, the trueness verification program used samples at three concentration levels to assess the bias, coefficient of variation (CV), and total error (TE) between the average measured values and the target value. Results The Spearman's rank correlation coefficient (rs) was ≥0.996 and the CCC ranged between 0.9448 and 0.9990 for each assay vs. all-assays median. Considering the all-assays median value of each sample as a reference, there were proportional and systematic differences according to the Passing-bablok regression analysis. The relative difference of the four assays (Abbott Architect i2000, Autolumo A2000, Diasorin Liaison XL, and Maccura IS1200) met the optimal analytical quality specifications. On the other hand, Beckman DxI800 (13.2 %) and Roche Cobas E601 (-9.0 %) were only able to fulfill the desirable analytical quality specifications. The average pass rates for bias, CV, and TE of the trueness verification program were 80 %, 98 %, and 96 %, respectively. Conclusions The six automated immunoassays vs. all-assays median have a good correlation in CEA detection. However, there is a lack of comparability of CEA results. Further improvements are needed in harmonization among CEA detections.
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Affiliation(s)
- Wenxuan Fu
- Department of Clinical Laboratory, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yuhong Yue
- Department of Clinical Laboratory, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yichuan Song
- Department of Clinical Laboratory, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Shunli Zhang
- Department of Clinical Laboratory, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Jie Shi
- Department of Clinical Laboratory, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Rui Zhao
- Department of Clinical Laboratory, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Qingtao Wang
- Department of Clinical Laboratory, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Rui Zhang
- Department of Clinical Laboratory, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
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2
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Ferraro S, Cereda C, Zuccotti G, Marcovina S, Plebani M, Biganzoli EM. Striving for a pragmatic contribution of biomarkers results to lifelong health care. Clin Chem Lab Med 2023; 61:1395-1403. [PMID: 36798037 DOI: 10.1515/cclm-2022-1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The increased role of preventive medicine in healthcare and the rapid technological advancements, have deeply changed the landscape of laboratory medicine. In particular, increased investments in newborn screening tests and policies have been observed. Aim of this paper is to characterize how laboratory professionals engaged in clinical chemistry or newborn screening, in collaboration with experts in econometric, bioinformatics, and biostatistics may address a pragmatic use of laboratory results in the decision-making process oriented toward improvement of health care outcomes. CONTENT The effectiveness of biomarkers on healthcare depends on several factors such as analytical performance, prevalence of the disease, integration of the test within the diagnostic algorithm, associated costs, and social/economic impact of false positive and false negative results. Cost-effectiveness analysis needs to be performed and reliability achieved, by overcoming analytical pitfalls and by improving interpretative criteria. These are challenging issues common to clinical chemistry and newborn screening tests. Following the experience in clinical chemistry, one of the main issues to be approached in newborn screening tests, is the lack of harmonization of results obtained by different methods and the limited healthcare effectiveness. SUMMARY The focus on prevention is a crucial opportunity for laboratory medicine to change how to approach the effectiveness of biomarkers on healthcare. The consolidation within clinical laboratories of professionals with different technical and methodological expertise coupled with the need to produce and manage large sets of data, require the cooperation of professionals from other disciplines to characterize the impact of the tests on epidemiological outcomes for health care policy making process.
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Affiliation(s)
- Simona Ferraro
- Department of Pediatrics, Center of Functional Genomics and Rare Diseases, Buzzi Children's Hospital, Milan, Italy
- Department of Pediatrics, Center of Functional Genomics and Rare Diseases, Buzzi Children's Hospital, Milan, Italy
| | - Cristina Cereda
- Department of Pediatrics, Center of Functional Genomics and Rare Diseases, Buzzi Children's Hospital, Milan, Italy
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | | | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Elia Mario Biganzoli
- Department of Biomedical and Clinical Sciences L. Sacco, Medical Statistics Unit, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
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Dlamini IS, Gounden V, Moodley N. Evaluation of tumour marker utilisation and impact of electronic gatekeeping in the province of KwaZulu-Natal, South Africa. Afr J Lab Med 2023; 12:2027. [PMID: 37434992 PMCID: PMC10331048 DOI: 10.4102/ajlm.v12i1.2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 04/13/2023] [Indexed: 07/13/2023] Open
Abstract
Background Inappropriate testing remains a high healthcare cost driver. Tumour marker tests are more expensive than routine chemistry testing. Implementing test demand management systems like electronic gatekeeping (EGK) has reportedly decreased test requests. Objective This study aimed to describe the appropriateness of tumour marker tests, carcinoembryonic antigen, alpha foetal protein, prostate-specific antigen, carbohydrate antigen 19-9, cancer antigen 15-3, cancer antigen 125, and human chorionic gonadotropin, and determine the effectiveness of the EGK used in the public health sector in KwaZulu-Natal, South Africa. Methods Tumour marker test data for the KwaZulu-Natal province were extracted from the National Health Laboratory Service Central Data Warehouse for 01 January 2017 - 30 June 2017 (pre-EGK) and 01 January 2018 - 30 June 2018 (post-EGK implementation). Questionnaires were sent to the clinicians in the regional hospitals ordering the most tumour marker tests to assess ordering practices. In addition, we assessed monthly rejection reports to determine the effect of the EGK. Results The EGK minimally reduced tumour marker requests or associated costs (1.4% average EGK rejection rate). An overall 18% increase in the tumour marker tests occurred in 2018. The data suggest inappropriate tumour marker test utilisation, particularly for screening. Conclusion The introduction of EGK as a test demand management had little impact on tumour marker test requests and costs. Continuous education and reiteration of indications for tumour marker test use are required. What this study adds This study demonstrates the ineffectiveness of EGK in tumour marker orders, and provides some insight as to why these markers are being ordered, which is important in trying to decrease inappropriate ordering of these tests.
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Affiliation(s)
- Immaculate S. Dlamini
- Department of Chemical Pathology, Faculty of Laboratory Medicine, National Health Laboratory Service, Durban, South Africa
- Department of Chemical Pathology, Faculty of Laboratory Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Verena Gounden
- Department of Chemical Pathology, Faculty of Laboratory Medicine, National Health Laboratory Service, Durban, South Africa
- Department of Chemical Pathology, Faculty of Laboratory Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Nareshni Moodley
- Department of Chemical Pathology, Faculty of Laboratory Medicine, National Health Laboratory Service, Durban, South Africa
- Department of Chemical Pathology, Faculty of Laboratory Medicine, University of KwaZulu-Natal, Durban, South Africa
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4
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Sheng JY, Snyder CF, Smith KC, DeSanto J, Mayonado N, Rall S, White S, Blackford AL, Johnston FM, Joyner RL, Mischtschuk J, Peairs KS, Thorner E, Tran PT, Wolff AC, Choi Y. Evaluating potential overuse of surveillance care in cancer survivors. Cancer Med 2023; 12:6139-6147. [PMID: 36369671 PMCID: PMC10028154 DOI: 10.1002/cam4.5346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Survivorship care plans (SCPs) communicate cancer-related information from oncology providers to patients and primary care providers. SCPs may limit overuse testing by specifying necessary follow-up care. From a randomized, controlled trial of SCP delivery, we examined whether cancer-related tests not specified in SCPs, but conducted after SCP receipt, were appropriate or consistent with overuse. METHODS Survivors of breast, colorectal, or prostate cancer treated at urban-academic or rural-community health systems were randomized to one of three SCP delivery arms. Tests during 18 months after SCP receipt were classified as consistent with overuse if they were (1) not included in SCPs and (2) on a guideline-based predetermined list of "not recommended surveillance." After chart abstraction, physicians performed review and adjudication of potential overuse. Descriptive analyses were conducted of tests consistent with overuse. Negative binomial regression models determined if testing consistent with overuse differed across study arms. RESULTS Among 316 patients (137 breast, 67 colorectal, 112 prostate), 140 individual tests were identified as potential overuse. Upon review, 98 were deemed to be consistent with overuse: 78 tumor markers and 20 imaging tests. The majority of overuse testing was breast cancer-related (95%). Across sites, 27 patients (9%) received ≥1 test consistent with overuse; most were breast cancer patients (22/27). Exploratory analyses of overuse test frequency by study arm showed no significant difference. CONCLUSIONS This analysis identified practice patterns consistent with overuse of surveillance testing and can inform efforts to improve guideline-concordant care. Future interventions may include individual practice patterns and provider education.
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Affiliation(s)
- Jennifer Y. Sheng
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | - Claire F. Snyder
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Katherine C. Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jennifer DeSanto
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Nancy Mayonado
- TidalHealth Richard A. Henson Research InstituteSalisburyMarylandUSA
| | - Susan Rall
- TidalHealth Richard A. Henson Research InstituteSalisburyMarylandUSA
| | - Sharon White
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Amanda L. Blackford
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | | | - Robert L. Joyner
- TidalHealth Richard A. Henson Research InstituteSalisburyMarylandUSA
| | - Joan Mischtschuk
- TidalHealth Richard A. Henson Research InstituteSalisburyMarylandUSA
| | - Kimberly S. Peairs
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | - Elissa Thorner
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | - Phuoc T. Tran
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | - Antonio C. Wolff
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer CenterBaltimoreMarylandUSA
| | - Youngjee Choi
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
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5
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Ferraro S, Cereda C, Zuccotti G, Biganzoli EM. Critical appraisal of "choosing which in-hospital laboratory tests to target for intervention: a scoping review". Clin Chem Lab Med 2023; 61:e48-e49. [PMID: 36427899 DOI: 10.1515/cclm-2022-1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Simona Ferraro
- Newborn Screening and Genetic Metabolic Diseases Unit, "V. Buzzi" Children's Hospital, Milan, Italy.,Endocrinology Laboratory Unit, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Cristina Cereda
- Newborn Screening and Genetic Metabolic Diseases Unit, "V. Buzzi" Children's Hospital, Milan, Italy.,Pediatric Department, "V. Buzzi" Children's Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, "V. Buzzi" Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
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6
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Kong W, Tu Y, Jiang P, Huang Y, Zhang J, Jiang S, Li N, Yuan R. Development and validation of a nomogram involving immunohistochemical markers for prediction of recurrence in early low-risk endometrial cancer. Int J Biol Markers 2022; 37:395-403. [DOI: 10.1177/03936155221132292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background The purpose of this study was to construct a nomogram based on classical parameters and immunohistochemical markers to predict the recurrence of early low-risk endometrial cancer patients. Methods A total of 998 patients with early low-risk endometrial cancer who underwent primary surgical treatment were enrolled (668 in the training cohort, 330 in the validation cohort). Prognostic factors identified by univariate and multivariate analysis in the training cohort were used to construct the nomogram. Prediction performance of the nomogram was evaluated using the calibration curve, concordance index (C-index), and the time-dependent receiver operating characteristic curve. The cumulative incidence curve was used to describe the prognosis of patients in high-risk and low-risk groups divided by the optimal risk threshold of the model. Results In the training cohort, grade ( P = 0.040), estrogen receptor ( P < 0.001), progesterone receptor ( P = 0.001), P53 ( P = 0.004), and Ki67 ( P = 0.002) were identified as independent risk factors of recurrence of early low-risk endometrial cancer, and were used to establish the nomogram. The calibration curve showed that the fitting degree of the model was good. The C-indexes of training and validation cohorts were 0.862 and 0. 827, respectively. Based on the optimal risk threshold of the nomogram, patients were split into a high-risk group and a low-risk group. The cumulative incidence curves showed that the prognosis of the high-risk group was far worse than that of the low-risk group ( P < 0.001). Conclusion This nomogram, with a combination of classical parameters and immunohistochemical markers, can effectively predict recurrence in early low-risk endometrial cancer patients.
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Affiliation(s)
- Wei Kong
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Gynecology, Guiqian International General Hospital, Guizhou, China
| | - Yuan Tu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Jiang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuzhen Huang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingni Zhang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shan Jiang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ning Li
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Yuan
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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7
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Panteghini M, Dolci A, Birindelli S, Szoke D, Aloisio E, Caruso S. Pursuing appropriateness of laboratory tests: a 15-year experience in an academic medical institution. Clin Chem Lab Med 2022; 60:1706-1718. [PMID: 35998662 DOI: 10.1515/cclm-2022-0683] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/08/2022] [Indexed: 02/04/2023]
Abstract
Appropriateness in Laboratory Medicine has been the object of various types of interventions. From published experiences, it is now clear that to effectively manage the laboratory test demand it is recommended to activate evidence-based preventative strategies stopping inappropriate requests before they can reach the laboratory. To guarantee appropriate laboratory test utilization, healthcare institutions should implement and optimize a computerized provider order entry (CPOE), exploiting the potential of electronic requesting as "enabling factor" for reinforcing appropriateness and sustaining its effects over time. In our academic institution, over the last 15 years, our medical laboratory has enforced various interventions to improve test appropriateness, all directly or indirectly based on CPOE use. The following types of intervention were implemented: (1) applying specific recommendations supported by monitoring by CPOE as well as a continuous consultation with clinicians (tumour markers); (2) removing outdated tests and avoiding redundant duplications (cardiac markers, pancreatic enzymes); (3) order restraints to selected wards and gating policy (procalcitonin, B-type natriuretic peptide, homocysteine); (4) reflex testing (bilirubin fractions, free prostate-specific antigen, aminotransferases, magnesium in hypocalcemia); and (5) minimum retesting interval (D-Dimer, vitamin B12, C-reactive protein, γ-glutamyltranspeptidase). In this paper, we reviewed these interventions and summarized their outcomes primarily related to the changes in total test volumes and cost savings, without neglecting patient safety. Our experience confirmed that laboratory professionals have an irreplaceable role as "stewards" in designing, implementing, evaluating, and maintaining interventions focused to improving test appropriateness.
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Affiliation(s)
- Mauro Panteghini
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy.,Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi, Milan, Italy
| | - Alberto Dolci
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy.,Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi, Milan, Italy
| | - Sarah Birindelli
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Dominika Szoke
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena Aloisio
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Simone Caruso
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
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8
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Bosch X, Molina R, Marrades R, Augé JM, Pellicé M, López-Soto A. Tumour markers with clinically controlled cut-offs for suspected cancer. Eur J Clin Invest 2021; 51:e13523. [PMID: 33594702 DOI: 10.1111/eci.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Due to insufficient scientific evidence, panels of tumour markers (TMs) are currently not recommended for use in suspected cancer. However, recent well-designed studies have revealed a potential clinical value in lung cancer. We analysed the diagnostic accuracy of a panel of 11 circulating TMs with clinically controlled thresholds in the differentiation of cancer from nonmalignant diseases. METHODS We prospectively recruited 4776 consecutive patients presenting with focal or nonspecific symptoms suggestive of cancer who underwent testing for 11 serum TMs before diagnosis was known. The study abided by 2015 STARD guidelines. Tumour markers included, among others, carbohydrate antigen 19-9, carcinoembryonic antigen, alpha-fetoprotein, squamous cell carcinoma-associated antigen, prostate-specific antigen (males), neuron-specific enolase, progastrin-releasing peptide and carbohydrate antigen 125. Thresholds were adjusted for the presence of kidney failure, liver disease, effusions and dermatological disorders. Results showing ≥1 TMs with concentrations above threshold were considered positive. RESULTS Benign diseases were diagnosed in 3281 (68.7%) patients and cancer in 1495 (31.3%), with epithelial cancers in 1214 (77% at stage IV). When applying criteria for controlled thresholds, overall specificity was 98%. Overall sensitivity of the panel in epithelial cancers was 72.2%, positive predictive value 93% and negative predictive value 90.5%. The area under the receiver operating characteristic curve was 0.920 (95% confidence interval, 0.902-0.924). CONCLUSIONS By using clinically controlled cut-offs, the combined panel demonstrated an excellent ability to discriminate epithelial cancers from nonmalignant diseases. However, its use in clinical practice would need formal validation through a multicentre controlled trial assessing a panel-guided strategy vs. standard diagnosis.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Rafael Molina
- Laboratory of Clinical Biochemistry (Unit for Cancer Research), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ramon Marrades
- Department of Respiratory Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Josep M Augé
- Laboratory of Clinical Biochemistry (Unit for Cancer Research), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Martina Pellicé
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alfonso López-Soto
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
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9
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Wang C, Gu Y, Men X, Sun P, Chen M. TAP Test Image Dynamic Tracking Study after Thyroid Cancer Surgery and after Radiotherapy and Chemotherapy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:8072126. [PMID: 33953794 PMCID: PMC8068541 DOI: 10.1155/2021/8072126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/10/2020] [Accepted: 03/22/2021] [Indexed: 12/01/2022]
Abstract
Thyroid cancer is a relatively common endocrine gland malignant tumor; if improper treatment, there will be a high risk of recurrence or metastasis, and abnormal sugar chain glycoprotein (TAP) has a close relationship with the development of the disease; therefore, the purpose of this article is to discuss abnormal sugar chain glycoprotein (TAP) as thyroid cancer curative effect evaluation and radiation and chemotherapy after surgery clinical significance. In this paper, 95 patients with thyroid cancer diagnosed in a hospital were selected as the study objects and treated as the observation group. The clinical and follow-up data of the observation group were retrospectively analyzed. Meanwhile, 55 healthy patients were randomly selected as the control group. TAP, squamous cell carcinoma antigen (SCC) level, and carcinoembryonic antigen (CEA) level were detected in peripheral blood of 95 patients with thyroid cancer before and after treatment. The short-term efficacy was evaluated by chest CT examination, and the changes of the three markers before and after treatment and the correlation with the short-term efficacy of the patients were compared. According to the results of testing, the TAP positive expression in patients before radiotherapy can better predict the recent curative effect has certain clinical value; before radiotherapy TAP positive expression rate was significantly higher than that of healthy people, TAP positive expression quantity decreased obviously after radiation treatment, and patients with a recent radiotherapy curative effect is good or bad and negatively correlated with the degree of TAP protein positive expression; TAP high protein in patients with recent poor radiation effects, prompt the factor can be predicted in the near future curative effect of the molecular markers, and can TAP level for clinicians provide certain reference for targeted therapy.
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Affiliation(s)
- Changliang Wang
- Department of Galactophore Surgery, Weifang People's Hospital, Shandong 261041, China
| | - Yongxue Gu
- Department of Galactophore Surgery, Weifang People's Hospital, Shandong 261041, China
| | - Xiaojuan Men
- Department of Galactophore Surgery, Weifang People's Hospital, Shandong 261041, China
| | - Peng Sun
- Weifang Medical University, Shandong 261041, China
| | - Meili Chen
- Weifang Brain Hospital Emergency Department, Shandong 261041, China
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10
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Al-Mughales JA, Alahwal MS. Inappropriate practice in tumor marker requests at a university hospital in Western Saudi Arabia: A 3-year retrospective study. Int J Biol Markers 2020; 35:35-43. [PMID: 33158390 DOI: 10.1177/1724600820971305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study assessed the level of appropriateness of tumor marker requests in a teaching hospital and estimated the financial cost associated with inappropriate use. METHODS A retrospective review of patients' electronic records was conducted over a 3-year period (2015-2017) for tumor marker requests, including carcinoembryonic antigen, alpha-fetoprotein, cancer antigen (CA)15-3, CA125, CA19-9, and total and free prostate-specific antigen (PSA and fPSA), along with the associated clinical data that motivated the requests. Inappropriate use was defined as tumor marker requests without any relevant clinical picture. Costs due to inappropriate tumor marker requests were estimated based on the unit costs applied in the institution. RESULTS A total of 7128 patients had at least one tumor marker request between 2015 and 2017. The clinical picture that motivated tumor marker requests was absent in 71.5%, while 12.9% of the requests were associated with a malignancy. The most frequent prescribing pattern was total prostate-specific antigen alone (2128; 29.9%), followed by alpha-fetoprotein alone (1185; 16.6%), and carcinoembryonic antigen alone (506; 7.1%). Year-over-year analysis revealed an increasing tendency in requesting carcinoembryonic antigen and CA15-3. The rate of inappropriate use varied by tumor marker and ranged between 56.4% for fPSA and 86.8% for total prostate-specific antigen. The overall costs due to inappropriate tumor marker requests were estimated at $2,785,493 over the 3 years, representing an average of $0.93 million per year. CONCLUSION Inappropriate use of tumor marker requests is a major issue regarding its high prevalence and the considerable associated costs. The role of laboratories in the management of tumor marker requests should be emphasized.
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Affiliation(s)
- Jamil A Al-Mughales
- Diagnostic Immunology Division, Department of Clinical Laboratory Medicine 1, Jeddah, Faculty of Medicine King Abdul-Aziz University/Kingdom of Saudi Arabia.,Department of Medical Microbiology and Parasitology/Medical Immunology Division, Faculty of Medicine, King Abdul-Aziz University, Jeddah, Kingdom of Saudi Arabia
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11
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Mislang A, Mollard R, Tapia Rico G, Fairlie WD, Lee EF, Harris TJ, Aston R, Brown MP. A preliminary assessment of oral monepantel's tolerability and pharmacokinetics in individuals with treatment-refractory solid tumors. Cancer Chemother Pharmacol 2020; 86:589-594. [PMID: 32960289 DOI: 10.1007/s00280-020-04146-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Monepantel is an approved veterinary anthelmintic with a strong safety profile. Preclinical evidence suggests novel mTOR pathway-associated anticancer activity. An open-label Phase I trial assessed tolerability, pharmacokinetics, pharmacodynamics and PET-CT imaging following oral Zolvix® monepantel administration to adults with treatment refractory, progressing and unresectable solid tumors. METHODS Subjects were scheduled to daily home-based monepantel administration for 28 days in a 3 + 3 dose escalation study (5.0, 25.0 and 62.5 mg/kg bw). RESULTS Of 41 reported drug-related AEs, 68% were Grade 1 and 24% were Grade 2; 35 AEs related to gastrointestinal effects including very poor palatability. DLT and MTD could not be determined due to early termination. Myelosuppression was not observed at the lowest level tested. Three of four Cohort 1 subjects had reduced mTOR pathway marker p-RPS6KB1 levels in PBMCs and achieved RECISTv1.1 SD by CT; one had progressive bony metastases by FDG-PET. One subject recorded PD on day 28, correlating with no detectable plasma monepantel from day 7. Monepantel sulfone dominated monepantel in pharmacokinetics. Both Cohort 2 subjects withdrew early due to AEs and the trial was terminated. CONCLUSIONS Short-term 5 mg/kg bw monepantel administration provides a combined steady-state trough plasma monepantel and monepantel sulfone concentration of 0.5 μM. Gastrointestinal AEs including very poor palatability are concerning and suggested to be resolved by future drug product reformulation. RECISTv1.1, p-RPS6KB1 and plasma tumor marker outcomes provide preliminary evidence of anticancer activity.
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Affiliation(s)
- Anna Mislang
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, 5000, Australia
| | - Richard Mollard
- PharmAust Ltd, Claremont, 6010, Australia
- Department of Veterinary and Agricultural Science, University of Melbourne, Parkville, 3052, Australia
| | - Gonzalo Tapia Rico
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, 5000, Australia
- School of Medicine, University of Adelaide, Adelaide, 5000, Australia
| | - W Douglas Fairlie
- Olivia Newton-John Cancer Research Institute, Heidelberg, 3084, Australia
- School of Cancer Medicine, La Trobe University, Heidelberg, 3084, Australia
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Sciences, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Erinna F Lee
- Olivia Newton-John Cancer Research Institute, Heidelberg, 3084, Australia
- School of Cancer Medicine, La Trobe University, Heidelberg, 3084, Australia
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Sciences, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Tiffany J Harris
- Olivia Newton-John Cancer Research Institute, Heidelberg, 3084, Australia
| | | | - Michael P Brown
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, 5000, Australia.
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, 5000, Australia.
- School of Medicine, University of Adelaide, Adelaide, 5000, Australia.
- Cancer Clinical Trials Unit, Department of Medical Oncology, 6E351, Royal Adelaide Hospital, Adelaide, 5000, Australia.
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12
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Mortaji P, Lebduska E. The Dangers of Using Tumor Markers to Evaluate Nonspecific Symptoms: A Teachable Moment. JAMA Intern Med 2020; 180:1004. [PMID: 32391883 DOI: 10.1001/jamainternmed.2020.1293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Parisa Mortaji
- Department of Internal Medicine, University of Colorado, Aurora
| | - Elena Lebduska
- Department of Internal Medicine, University of Colorado, Aurora
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13
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Impact of a do-not-do intervention on 12 laboratory measurements. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Zambrana-García JL, Macías Blanco C, Fernández-Suárez A, Peñacoba Masa A, Olivares Durán MJ, Aguilar Benítez JM, Zambrana-Luque JL. Impact of a do-not-do intervention on 12 laboratory measurements. Rev Clin Esp 2017; 217:454-459. [PMID: 28830616 DOI: 10.1016/j.rce.2017.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/21/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES In recent years, various scientific societies and healthcare organisations have created recommendations aimed at decreasing the use of healthcare interventions that have shown no efficacy or effectiveness. The aim of this study was to assess the impact of an intervention on 12 do-not-do recommendations regarding the laboratory in 7 hospital centres. METHODS Before-after study conducted in 7 hospital centres of Cordoba and Jaen during 2015 and 2016. Based on the recommendations of existing scientific societies, a consensus was reached on various actions regarding laboratory measurements. We analysed the number and cost of measuring 6 tumour markers (carcinoembryonic antigen, prostate-specific antigen, carbohydrate antigen [CA] 15.3, CA125, CA19.9 and alpha-fetoprotein), thyrotropin, T3, T4, glycated haemoglobin, urea, ferritin and antigliadin antibodies, before and after implementing the consensus. RESULTS Compared with the previous year, there were 55,902 fewer laboratory measurements (-19%) in 2016, with an overall savings of €82,100. The reduction in the number of measurements occurred mainly in plasma urea (-50.3%) and in the tumour markers CA125 (-16%), CA19.9 (-11.6%) and CA15.3 (-10.5%). The most pronounced savings were achieved in the measurements of urea (-€21,002), thyroid hormones (-€12,716) and thyrotropin (-€7,638). CONCLUSIONS The adoption and consensus of do-not-do recommendations among healthcare levels resulted in a significant reduction in unnecessary measurements.
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Affiliation(s)
| | - C Macías Blanco
- Línea de Biotecnología, Hospital de Montilla, Montilla, Córdoba, España
| | - A Fernández-Suárez
- Línea de Biotecnología, Hospital Alto Guadalquivir, Andújar, Jaén, España; Línea de Biotecnología, Hospital Valle del Guadiato, Peñarroya, Córdoba, España
| | - A Peñacoba Masa
- Área de Biotecnología, Hospital de Alta Resolución de Puente Genil, Puente Genil, Córdoba, España
| | - M J Olivares Durán
- Área de Biotecnología, Hospital de Alta Resolución Sierra de Segura, Puente Génave, Jaén, España
| | - J M Aguilar Benítez
- Área de Biotecnología, Hospital de Alta Resolución Alcalá la Real, Alcalá la Real, Jaén, España; Área de Biotecnología, Hospital de Alta Resolución Alcaudete, Alcaudete, Jaén, España
| | - J L Zambrana-Luque
- Coordinación Asistencial, Hospital de Montilla, Montilla, Córdoba, España
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15
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Dolci A, Giavarina D, Pasqualetti S, Szőke D, Panteghini M. Total laboratory automation: Do stat tests still matter? Clin Biochem 2017; 50:605-611. [PMID: 28390779 DOI: 10.1016/j.clinbiochem.2017.04.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
During the past decades the healthcare systems have rapidly changed and today hospital care is primarily advocated for critical patients and acute treatments, for which laboratory test results are crucial and need to be always reported in predictably short turnaround time (TAT). Laboratories in the hospital setting can face this challenge by changing their organization from a compartmentalized laboratory department toward a decision making-based laboratory department. This requires the implementation of a core laboratory, that exploits total laboratory automation (TLA) using technological innovation in analytical platforms, track systems and information technology, including middleware, and a number of satellite specialized laboratory sections cooperating with care teams for specific medical conditions. In this laboratory department model, the short TAT for all first-line tests performed by TLA in the core laboratory represents the key paradigm, where no more stat testing is required because all samples are handled in real-time and (auto)validated results dispatched in a time that fulfills clinical needs. To optimally reach this goal, laboratories should be actively involved in managing all the steps covering the total examination process, speeding up also extra-laboratory phases, such sample delivery. Furthermore, to warrant effectiveness and not only efficiency, all the processes, e.g. specimen integrity check, should be managed by middleware through a predefined set of rules defined in light of the clinical governance.
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Affiliation(s)
- Alberto Dolci
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Davide Giavarina
- Clinical Chemistry and Hematology Laboratory, "San Bortolo" Hospital, Vicenza, Italy
| | - Sara Pasqualetti
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Dominika Szőke
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan Medical School, Milan, Italy
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16
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Ferraro S, Panteghini M. The role of laboratory in ensuring appropriate test requests. Clin Biochem 2017; 50:555-561. [PMID: 28284827 DOI: 10.1016/j.clinbiochem.2017.03.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 12/15/2022]
Abstract
This review highlights the role of laboratory professionals and the strategies to be promoted in strict cooperation with clinicians for auditing, monitoring and improving the appropriateness of test request. The introduction of local pathways and care maps in agreement with international and national guidelines as well as the implementation of reflex testing and algorithms have a central role in guiding test request and in correcting the overuse/misuse of tests. Furthermore, removing obsolete tests from laboratory menu and vetting of restricted tests is recommended to increase cost-effectiveness. This saves costs and permits to introduce new biomarkers with increased diagnostic accuracy with a better impact on patient outcome. An additional issue is concerning the periodicity of (re)testing, accounting that only a minority of tests may be ordered as often as necessary. In the majority of cases, a minimum retesting interval should be introduced. The availability of effective computerised order entry systems is relevant in ensuring appropriate test requests and in providing an aid by automated rules that may stop inappropriate requests before they reach the laboratory.
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Affiliation(s)
- Simona Ferraro
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, University of Milan, Milan, Italy.
| | - Mauro Panteghini
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, University of Milan, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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