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Dittadi R. Interferences in immunoassay: An estimate based on 'real-world' experience. Ann Clin Biochem 2024:45632241240306. [PMID: 38497516 DOI: 10.1177/00045632241240306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Ruggero Dittadi
- Laboratory Medicine Unit, Ospedale dell'Angelo, ULSS 3 Serenissima, Mestre, Venice, Italy
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2
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Zancanaro A, RIzzo F, Dittadi R. Is polyethylene glycol allergy a real contraindication to COVID-19 mRNA vaccines? Eur Ann Allergy Clin Immunol 2023; 55:243-245. [PMID: 35586935 DOI: 10.23822/eurannaci.1764-1489.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A Zancanaro
- Internal Medicine Unit, Ospedale dell'Angelo, ULSS 3 Serenissima, Mestre, Venice, Italy
| | - F RIzzo
- Internal Medicine Unit, Ospedale dell'Angelo, ULSS 3 Serenissima, Mestre, Venice, Italy
| | - R Dittadi
- Laboratory Medicine Unit, Ospedale dell'Angelo, ULSS 3 Serenissima, Mestre, Venice, Italy
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3
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Clerico A, Zaninotto M, Aimo A, Cardinale DM, Dittadi R, Sandri MT, Perrone MA, Belloni L, Fortunato A, Trenti T, Plebani M. Variability of cardiac troponin levels in normal subjects and in patients with cardiovascular diseases: analytical considerations and clinical relevance. Clin Chem Lab Med 2023; 61:1209-1229. [PMID: 36695506 DOI: 10.1515/cclm-2022-1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
In accordance with all the most recent international guidelines, the variation of circulating levels of cardiac troponins I and T, measured with high-sensitivity methods (hs-cTnI and hs-cTnT), should be used for the detection of acute myocardial injury. Recent experimental and clinical evidences have demonstrated that the evaluation of hs-cTnI and hs-cTnT variations is particularly relevant: a) for the differential diagnosis of Acute Coronary Syndromes (ACS) in patients admitted to the Emergency Department (ED); b) for the evaluation of cardiovascular risk in patients undergoing major cardiac or non-cardiac surgery, and in asymptomatic subjects of the general population aged >55 years and with co-morbidities; c) for the evaluation of cardiotoxicity caused by administration of some chemotherapy drugs in patients with malignant tumors. The aim of this document is to discuss the fundamental statistical and biological considerations on the intraindividual variability of hs-cTnI and hs-cTnT over time in the same individual. Firstly, it will be discussed in detail as the variations of circulating levels strictly depend not only on the analytical error of the method used but also on the intra-individual variability of the biomarker. Afterwards, the pathophysiological interpretation and the clinical relevance of the determination of the variability of the hs-cTnI and hs-cTnT values in patients with specific clinical conditions are discussed. Finally, the evaluation over time of the variation in circulating levels of hs-cTnI and hs-cTnT is proposed for a more accurate estimation of cardiovascular risk in asymptomatic subjects from the general population.
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Affiliation(s)
- Aldo Clerico
- Scuola Superiore Sant'Anna e Fondazione CNR, Regione Toscana G. Monasterio, Pisa, Italy
| | - Martina Zaninotto
- Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova, Padova, Italy
- Azienda Ospedaliera Universitaria di Padova, e Facoltà di Medicina e Chirurgia, Università di Padova, Padova, Italy
| | - Alberto Aimo
- Scuola Superiore Sant'Anna e Fondazione CNR, Regione Toscana G. Monasterio, Pisa, Italy
| | | | - Ruggero Dittadi
- Unità di Medicina di Laboratorio, Ospedale dell'Angelo, e Centro Regionale dei Biomarcatori, Dipartimento di Patologia Clinica, Azienda ULSS 3, Mestre, Italy
| | - Maria T Sandri
- Laboratorio Bianalisi, Carate Brianza, Monza e Brianza, Italy
| | - Marco Alfonso Perrone
- Dipartimento di Biochimica Clinica e Divisione di Cardiologia, Università e Ospedale di Tor Vergata, Rome, Italy
| | - Lucia Belloni
- Unità di Immunologia Clinica, Allergia e Biotecnologie Avanzate, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Tommaso Trenti
- Dipartimento di Patologia Clinica e Laboratorio, Azienda USL of Modena, Modena, Italy
| | - Mario Plebani
- Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova, Padova, Italy
- Azienda Ospedaliera Universitaria di Padova, e Facoltà di Medicina e Chirurgia, Università di Padova, Padova, Italy
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Gion M, De Gobbi R, Zorzi M, Carretta G, Leonardi L, Guzzinati S, Trevisiol C, Cancian M, Cardinali G, Michieletto F, Dittadi R, Fabricio ASC, Rugge M, Russo F. Overordering of tumor marker for outpatients revealed by performance indicators and the impact of a health policy intervention: An observational study using administrative records. Int J Biol Markers 2023; 38:61-71. [PMID: 36855811 DOI: 10.1177/03936155231154663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
PURPOSE The overuse of laboratory tests contributes to impair health systems effectiveness, tumor markers (TMs) being a paradigmatic example. In the present study we applied indicators of TMs appropriateness developed from administrative datasets to appraise regionwide overordering in the clinical practice. PATIENTS AND METHODS TMs ordered to outpatients in the Veneto Region over 6 years were obtained from the eletronic Outpatients' Records of Diagnostic and Therapeutic Procedures. TMs orders were examined as aggregated data or stratified according to disease codes, gender, age, and requests per patient. TMs recommended only for specific malignancies were examined using epidemiological data obtained from Veneto Tumor Registry. RESULTS A total of 5,821,251 TMs were ordered in 4,382,159 patients over 6 years. Overall, 3,252,389 (55.9%) TMs were ordered without appropriate disease codes (ranging from 77.0% for PSA to 17.5% for CA15.3). TM orders declined over 6 years (-13.4%), with a noticeable reduction of orders without appropriate disease codes (-21.3%). Orders decreased sharply from 2015 to 2016, after the enactment of a national Decree-Law aimed at improving appropriateness, and remained stable thereafter. However, the rate of inappropriate TMs requests still remained elevated (44.4%) in the last year of observation, with orders of TMs being much higher than expected on the basis of prevalence and incidence figures of specific malignancies. CONCLUSIONS Indicators developed from administrative datasets were effective in assessing the overordering of TMs and the impact of interventions to improve appropriateness. The developed indicators could be considered for other diagnostic tests.
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Affiliation(s)
- Massimo Gion
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Roberto De Gobbi
- UOC Analisi Attività Assistenziali Sanitarie e Socio Sanitarie, Azienda Zero - Veneto Region, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero - Veneto Region, Padua, Italy
| | | | - Luca Leonardi
- Engineering Ingegneria Informatica spa, Padua, Italy
| | | | | | | | - Giulia Cardinali
- Management Control Unit, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Federica Michieletto
- Regional Directorate of Prevention, Food Safety, Veterinary, Veneto Region, Venice, Italy
| | - Ruggero Dittadi
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | | | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero - Veneto Region, Padua, Italy
| | - Francesca Russo
- Regional Directorate of Prevention, Food Safety, Veterinary, Veneto Region, Venice, Italy
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Clerico A, Zaninotto M, Aimo A, Musetti V, Perrone M, Padoan A, Dittadi R, Sandri MT, Bernardini S, Sciacovelli L, Trenti T, Malloggi L, Moretti M, Burgio MA, Manno ML, Migliardi M, Fortunato A, Plebani M. Evaluation of the cardiovascular risk in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers. A consensus document by the Inter-Society Study Group on Cardiac Biomarkers of the Italian Societies of Clinical Biochemistry: European Ligand Assay Society (ELAS), Italian section; Società Italiana di Biochimica Clinica e Biologia Molecolare Clinica (SIBioC); Società Italiana di Patologia Clinica e Medicina di Laboratorio (SIPMel). Clin Chem Lab Med 2022; 60:1525-1542. [PMID: 35858238 DOI: 10.1515/cclm-2022-0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022]
Abstract
Major adverse cardiovascular events are frequently observed in patients undergoing major non-cardiac surgery during the peri-operative period. At this time, the possibility to predict cardiovascular events remains limited, despite the introduction of several algorithms to calculate the risk of adverse events, mainly death and major adverse cardiovascular events (MACE) based on the clinical history, risk factors (sex, age, lipid profile, serum creatinine) and non-invasive cardiac exams (electrocardiogram, echocardiogram, stress tests). The cardiac-specific biomarkers natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the peri-operative period, particularly for the identification of myocardial injury in patients undergoing major non-cardiac surgery. The prognostic information from the measurement of BNP/NT-proBNP and hs-cTn is independent and complementary to other important indicators of risk, also including ECG and imaging techniques. Elevated levels of cardiac-specific biomarkers before surgery are associated with a markedly higher risk of MACE during the peri-operative period. BNP/NT-proBNP and hs-cTn should be measured in all patients during the clinical evaluation before surgery, particularly during intermediate- or high-risk surgery, in patients aged >65 years and/or with comorbidities. Several questions remain to be assessed in dedicated clinical studies, such as how to optimize the management of patients with raised cardiac specific biomarkers before surgery, and whether a strategy based on biomarker measurement improves patient outcomes and is cost-effective.
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Affiliation(s)
- Aldo Clerico
- Scuola Superiore Sant'Anna e Fondazione CNR-Regione Toscana G. Monasterio, Pisa, Italy
| | - Martina Zaninotto
- Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova e Azienda Ospedaliera Universitaria di Padova, e Dipartimento di Medicina-Università di Padova, Padova, Italy
| | - Alberto Aimo
- Scuola Superiore Sant'Anna e Fondazione CNR-Regione Toscana G. Monasterio, Pisa, Italy
| | - Veronica Musetti
- Scuola Superiore Sant'Anna e Fondazione CNR-Regione Toscana G. Monasterio, Pisa, Italy
| | - Marco Perrone
- Dipartimento di Medicina Sperimentale, Università di Roma Tor Vergata, Roma, Italy
| | - Andrea Padoan
- Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova e Azienda Ospedaliera Universitaria di Padova, e Dipartimento di Medicina-Università di Padova, Padova, Italy
| | | | | | - Sergio Bernardini
- Dipartimento di Medicina Sperimentale, Università di Roma Tor Vergata, Roma, Italy
| | - Laura Sciacovelli
- Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova e Azienda Ospedaliera Universitaria di Padova, e Dipartimento di Medicina-Università di Padova, Padova, Italy
| | - Tommaso Trenti
- Dipartimento di Medicina di Laboratorio e Anatomia Patologica, Azienda Ospedaliera Universitaria e USL di Modena, Modena, Italy
| | - Lucia Malloggi
- Laboratorio Analisi, Azienda Ospedaliera-Universitaria di Pisa, Pisa, Italy
| | - Marco Moretti
- Medicina di Laboratorio, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | | | | | - Marco Migliardi
- Laboratorio Analisi, Ospedale Ordine Mauriziano, Torino, Italy
| | | | - Mario Plebani
- Dipartimento di Medicina di Laboratorio-DIMED, Università di Padova, Padova, Italy
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Dittadi R, Fabricio ASC, Gion M. Biological variation and reference change value as decision criteria in clinical use of tumor biomarkers. Are they really useful? Clin Chem Lab Med 2022; 60:e136-e137. [PMID: 35263822 DOI: 10.1515/cclm-2022-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/23/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Ruggero Dittadi
- Laboratory Medicine Unit, Department of Clinical Pathology, Ospedale dell'Angelo, Azienda ULSS 3 Serenissima, Mestre, Venice, Italy.,Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
| | | | - Massimo Gion
- Regional Center for Biomarkers, Department of Clinical Pathology, Azienda ULSS 3 Serenissima, Venice, Italy
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Clerico A, Zaninotto M, Aimo A, Dittadi R, Cosseddu D, Perrone M, Padoan A, Masotti S, Belloni L, Migliardi M, Fortunato A, Trenti T, Malloggi L, Cappelletti P, Galli GA, Bernardini S, Sciacovelli L, Plebani M. Use of high-sensitivity cardiac troponins in the emergency department for the early rule-in and rule-out of acute myocardial infarction without persistent ST-segment elevation (NSTEMI) in Italy. Clin Chem Lab Med 2021; 60:169-182. [PMID: 34927403 DOI: 10.1515/cclm-2021-1085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022]
Abstract
Serial measurements of cardiac troponin are recommended by international guidelines to diagnose myocardial infarction (MI) since 2000. However, some relevant differences exist between the three different international guidelines published between 2020 and 2021 for the management of patients with chest pain and no ST-segment elevation. In particular, there is no agreement on the cut-offs or absolute change values to diagnose non-ST-segment elevation MI (NSTEMI). Other controversial issues concern the diagnostic accuracy and cost-effectiveness of cut-off values for the most rapid algorithms (0 h/1 h or 0 h/2 h) to rule-in and rule-out NSTEMI. Finally, another important point is the possible differences between demographic and clinical characteristics of patients enrolled in multicenter trials compared to those routinely admitted to the Emergency Department in Italy. The Study Group of Cardiac Biomarkers, supported by the Italian Scientific Societies Società Italiana di Biochimica Clinica, Italian Society of the European Ligand Assay Society, and Società Italiana di Patolgia Clinica e Medicina di Laboratorio decided to revise the document previously published in 2013 about the management of patients with suspected NSTEMI, and to provide some suggestions for the use of these biomarkers in clinical practice, with a particular focus on the Italian setting.
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Affiliation(s)
- Aldo Clerico
- Fondazione CNR Regione Toscana G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy.,Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Alberto Aimo
- Fondazione CNR Regione Toscana G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Ruggero Dittadi
- Ospedale dell'Angelo ULSS 3 Serenissima, Laboratorio di Analisi Cliniche, Mestre, Italy
| | - Domenico Cosseddu
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | - Marco Perrone
- Division of Cardiology and Clinical Biochemistry, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Padoan
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Silvia Masotti
- Fondazione CNR Regione Toscana G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Lucia Belloni
- Dipartimento di Medicina di laboratorio, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Marco Migliardi
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | | | - Tommaso Trenti
- Azienda Ospedaliero - Universitaria Policlinico di Modena c/o Ospedale Civile di Baggiovara, Modena, Italy
| | - Lucia Malloggi
- Laboratorio Analisi, Azienda Ospedaliera-Universitaria di Pisa, Pisa, Italy
| | | | | | - Sergio Bernardini
- Division of Cardiology and Clinical Biochemistry, University of Rome Tor Vergata, Rome, Italy
| | - Laura Sciacovelli
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
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Padoan A, Clerico A, Zaninotto M, Trenti T, Tozzoli R, Aloe R, Alfano A, Rizzardi S, Dittadi R, Migliardi M, Bagnasco M, Plebani M. Percentile transformation and recalibration functions allow harmonization of thyroid-stimulating hormone (TSH) immunoassay results. Clin Chem Lab Med 2021; 58:1663-1672. [PMID: 31927515 DOI: 10.1515/cclm-2019-1167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 01/22/2023]
Abstract
Background The comparability of thyroid-stimulating hormone (TSH) results cannot be easily obtained using SI-traceable reference measurement procedures (RPMs) or reference materials, whilst harmonization is more feasible. The aim of this study was to identify and validate a new approach for the harmonization of TSH results. Methods Percentile normalization was applied to 125,419 TSH results, obtained from seven laboratories using three immunoassays (Access 3rd IS Thyrotropin, Beckman Coulter Diagnostics; Architect System, Abbott Diagnostics and Elecsys, Roche Diagnostics). Recalibration equations (RCAL) were derived by robust regressions using bootstrapped distribution. Two datasets, the first of 119 EQAs, the second of 610, 638 and 639 results from Access, Architect and Elecsys TSH results, respectively, were used to validate RCAL. A dataset of 142,821 TSH values was used to derive reference intervals (RIs) after applying RCAL. Results Access, Abbott and Elecsys TSH distributions were significantly different (p < 0.001). RCAL intercepts and slopes were -0.003 and 0.984 for Access, 0.032 and 1.041 for Architect, -0.031 and 1.003 for Elecsys, respectively. Validation using EQAs showed that before and after RCAL, the coefficients of variation (CVs) or among-assay results decreased from 10.72% to 8.16%. The second validation dataset was used to test RCALs. The median of between-assay differences ranged from -0.0053 to 0.1955 mIU/L of TSH. Elecsys recalibrated to Access (and vice-versa) showed non-significant difference. TSH RI after RCAL resulted in 0.37-5.11 mIU/L overall, 0.49-4.96 mIU/L for females and 0.40-4.92 mIU/L for males. A significant difference across age classes was identified. Conclusions Percentile normalization and robust regression are valuable tools for deriving RCALs and harmonizing TSH values.
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Affiliation(s)
- Andrea Padoan
- Department of Medicine (DIMED), University of Padova, via Giustiniani 2, 35128, Padova, Italy.,Department of Laboratory Medicine, University-Hospital of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Aldo Clerico
- Laboratory of Cardiovascular Endocrinology and Cell Biology, Department of Laboratory Medicine, Fondazione CNR-Regione Toscana Gabriele Monasterio, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Tommaso Trenti
- Dipartimento di Medicina di Laboratorio e Anatomia Patologica, Azienda Ospedaliera Universitaria e USL di Modena, Modena, Italy
| | - Renato Tozzoli
- Clinical Pathology Laboratory, Department of Laboratory Medicine, Azienda per l'Assistenza Sanitaria n.5, Pordenone Hospital, Pordenone, Italy
| | - Rosalia Aloe
- Dipartimento di Biochimica ad Elevata Automazione, Dipartimento Diagnostico, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Antonio Alfano
- Clinical Pathology, Hospital ASL TO4, Ciriè, Turin, Italy
| | - Sara Rizzardi
- Laboratorio Analisi Aziendale (SC), Azienda Socio-Sanitaria Territoriale di Cremona, Istituti Ospitalieri, Cremona, Italy
| | - Ruggero Dittadi
- U.O.C. Laboratorio Analisi, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Marco Migliardi
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | | | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy.,Department of Medicine (DIMED), University of Padova, Padova, Italy
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Dittadi R, Bertoli I, Carraro P. Reportable range of quantitative assays for SARS-CoV-2 antibodies determination: An overlooked issue? Ann Clin Biochem 2021; 58:673-675. [PMID: 34006122 DOI: 10.1177/00045632211020047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ruggero Dittadi
- Laboratory Medicine Unit, Ospedale dell'Angelo, ULSS 3 Serenissima, Mestre, Italy
| | - Isabella Bertoli
- Laboratory Medicine Unit, Ospedale dell'Angelo, ULSS 3 Serenissima, Mestre, Italy
| | - Paolo Carraro
- Laboratory Medicine Unit, Ospedale dell'Angelo, ULSS 3 Serenissima, Mestre, Italy
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10
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Affiliation(s)
- Ruggero Dittadi
- Laboratory Medicine Unit, Ospedale dell'Angelo, Mestre-Venice, Italy
| | - Paolo Carraro
- Laboratory Medicine Unit, Ospedale dell'Angelo, Mestre-Venice, Italy
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11
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Dittadi R, Afshar H, Carraro P. Two SARS-CoV-2 IgG immunoassays comparison and time-course profile of antibodies response. Diagn Microbiol Infect Dis 2021; 99:115297. [PMID: 33388574 PMCID: PMC7836402 DOI: 10.1016/j.diagmicrobio.2020.115297] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/04/2020] [Accepted: 12/12/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The persistence of circulating antibodies to SARS-CoV-2 infection is not yet well known. We compare the results of 2 automated systems for the determination of IgG against SARS CoV-2 and assess the time-course of the IgG response. METHODS IgG were measured in 103 specimens of 55 patients with COVID-19 (time from the symptoms' onset: 3-187 days) using the automated tests "Abbott SARS-COV-2 IgG" and "MAGLUMI 2019-nCoV IgG". RESULTS The 2 methods had a concordance of 90.3%, but the quantitative correlation, although significant, showed dispersed results. All the specimens resulted positive after 17 days. However, the median concentrations of IgG rapidly increased up to 20 days and decreased for Maglumi IgG while Abbott IgG showed a constant trend up to 85 days, and then slowly declined. CONCLUSIONS The titer of IgG against SARS-CoV-2 may significantly and rapidly decrease, but with a very different time-course depending on the method used for the determination.
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Affiliation(s)
- Ruggero Dittadi
- Laboratory Medicine Unit, Ospedale dell'Angelo, Mestre, Italy.
| | - Haleh Afshar
- Laboratory Medicine Unit, Ospedale dell'Angelo, Mestre, Italy
| | - Paolo Carraro
- Laboratory Medicine Unit, Ospedale dell'Angelo, Mestre, Italy
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12
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Dittadi R, Fabricio ASC, Rainato G, Peroni E, Di Tonno F, Vezzù B, Mazzariol C, Squarcina E, Tammone L, Gion M. Preanalytical stability of [-2]proPSA in whole blood stored at room temperature before separation of serum and plasma: implications to Phi determination. Clin Chem Lab Med 2019; 57:521-531. [PMID: 30218601 DOI: 10.1515/cclm-2018-0596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/11/2018] [Indexed: 12/26/2022]
Abstract
Background [-2]proPSA seems to outperform free/total prostate-specific antigen (PSA) ratio in prostate cancer diagnosis. However, [-2]proPSA stability remains an underestimated issue. We examined [-2]proPSA stability over time in whole blood before separation of serum and plasma and its implications for prostate health index (Phi) determination. Total PSA (tPSA) and free PSA (fPSA) stabilities were also assessed. Methods Blood was drawn from 26 patients and separated in two tubes for plasma (K2EDTA and K2EDTA plus protease inhibitors - P100) and one for serum (clot activator plus gel separator). Tubes were stored at room temperature before centrifugation 1, 3 and 5 h for serum and EDTA plasma or 1 and 5 h for P100 plasma. To investigate the influence of gel separator on markers' stability, blood was collected from 10 patients in three types of tubes to obtain serum: tubes with clot activator plus gel separator, with silica particles or glass tubes. Biomarkers were assayed with chemiluminescent immunoassays. Results [-2]proPSA and Phi levels significantly and progressively increased over time in serum (+4.81% and +8.2% at 3 h; +12.03% and +14.91% at 5 h, respectively, vs. 1 h; p<0.001). Conversely, [-2]proPSA levels did not change in plasma (EDTA or P100). tPSA levels did not change over time in serum or plasma, whereas fPSA decreased in serum. All markers were higher in plasma than in serum at any time point. This difference did not seem to be attributable to the use of gel for serum preparation. Conclusions EDTA prevented spurious in vitro modifications in PSA-related isoforms, confirming that a stabilized blood sample is a prerequisite for [-2]proPSA measurement and Phi determination.
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Affiliation(s)
- Ruggero Dittadi
- Laboratory Analysis Unit, Department of Clinical Pathology and Transfusion Medicine, Dell'Angelo Hospital, Mestre-Venice (VE), Italy
| | - Aline S C Fabricio
- Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine, SS Giovanni e Paolo Regional Hospital, Venice (VE), Italy
| | - Giulia Rainato
- Istituto Oncologico Veneto (IOV), IRCCS, Padua (PD), Italy
| | - Edoardo Peroni
- Istituto Oncologico Veneto (IOV), IRCCS, Padua (PD), Italy
| | - Fulvio Di Tonno
- Unit of Urology, dell'Angelo Regional General Hospital, Mestre-Venice (VE), Italy
| | - Beatrice Vezzù
- Unit of Urology, dell'Angelo Regional General Hospital, Mestre-Venice (VE), Italy
| | - Chiara Mazzariol
- Unit of Urology, dell'Angelo Regional General Hospital, Mestre-Venice (VE), Italy
| | - Elisa Squarcina
- Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine, SS Giovanni e Paolo Regional Hospital, Venice (VE), Italy
| | - Laura Tammone
- Endoscopy Ward, dell'Angelo Hospital, dell'Angelo Regional General Hospital, Mestre-Venice (VE), Italy
| | - Massimo Gion
- Centro Regionale Biomarcatori, AULSS3 Serenissima, Department of Clinical Pathology and Transfusion Medicine, SS Giovanni e Paolo Regional Hospital, Campo SS Giovanni e Paolo 6777, Ospedale Civile, 30122 Venezia, Italy
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Dittadi R, Polesello V, Zivi A, Carraro P. Evaluation of the possible interference of abiraterone therapy on testosterone immunoassay. Clin Chem Lab Med 2019; 57:e253-e254. [PMID: 30875318 DOI: 10.1515/cclm-2018-1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/16/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Ruggero Dittadi
- Laboratory Medicine Department, Ospedale dell'Angelo, ULSS 3 Serenissima, Via Paccagnella 11, 30174 Mestre (Venice), Italy
| | - Vania Polesello
- Laboratory Medicine Department, Ospedale dell'Angelo, ULSS 3 Serenissima, Mestre (Venice), Italy
| | - Andrea Zivi
- Medical Oncology Department, AOUI Verona, Verona, Italy.,Section of Cancer, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Paolo Carraro
- Laboratory Medicine Department, Ospedale dell'Angelo, ULSS 3 Serenissima, Mestre (Venice), Italy
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Dittadi R. The challenge of the reference intervals determination: An example from two articles published in the present issue. Int J Biol Markers 2019; 33:553-554. [PMID: 30764691 DOI: 10.1177/1724600818817561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Masotti S, Musetti V, Aloe R, Rizzardi S, Dittadi R, Carrozza C, Perrone M, Fasano T, de Santis A, Prontera C, Guiotto C, Clerico A. Evaluation of 99th percentile value of a chemiluminescence enzyme immunoassay (CLEIA) for cTnI using the automated AIA-CL2400 platform. Clin Chim Acta 2019; 496:45-47. [PMID: 31228415 DOI: 10.1016/j.cca.2019.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Silvia Masotti
- Laboratorio Clinico, Fondazione CNR-Regione Toscana, G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Veronica Musetti
- Laboratorio Clinico, Fondazione CNR-Regione Toscana, G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Rosalia Aloe
- S. S. Dipartimentale Biochimica ad Elevata Automazione, Dipartimento Diagnostico Azienda Ospedaliero, Universitaria di Parma, Parma, Italy
| | - Sara Rizzardi
- Azienda Socio-Sanitaria Territoriale di Cremona, UO Laboratorio analisi chimico cliniche e microbiologiche, Cremona, Italy
| | | | - Cinzia Carrozza
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marco Perrone
- Dipartimento di Medicina Sperimentale, Università di Roma Tor Vergata, Roma, Italy
| | - Tommaso Fasano
- Laboratorio Analisi Chimico-Cliniche ed Endocrinologia-ASMN, Azienda Ospedaliera di Reggio Emilia, Italy
| | - Antonio de Santis
- Laboratorio di Analisi Cliniche e Microbiologiche, P.O. San Paolo - ASL Bari, Bari, Italy
| | - Concetta Prontera
- Laboratorio Clinico, Fondazione CNR-Regione Toscana, G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Cristina Guiotto
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | - Aldo Clerico
- Laboratorio Clinico, Fondazione CNR-Regione Toscana, G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy.
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16
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Fabricio ASC, Michilin S, Zancan M, Agnolon V, Peloso L, Dittadi R, Scapinello A, Ceccarelli C, Gion M. Shed HER2 surrogacy evaluation in primary breast cancer patients: a study assessing tumor tissue HER2 expression at both extracellular and intracellular levels. Scand J Clin Lab Invest 2019; 79:260-267. [PMID: 30982358 DOI: 10.1080/00365513.2019.1600200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of the present study was to investigate serum HER2 extracellular domain (ECD) as a putative surrogate marker of the shedding phenomenon of HER2 receptor from the tumor tissue of primary breast cancer (BC) patients. A pilot retrospective study was conducted on 100 matched serum and tissue samples from patients with node-positive primary BC, stage II/III. Analysis of association and concordance between serum HER2 ECD levels (measured by chemiluminescence immunoassay) and the expression in matched tumor tissue of HER2 ECD and intracellular receptor domain (ICD) (determined by immunohistochemistry) were performed. The median serum HER2 ECD level was 9.4 ng/ml and cutoff values were set at 15.2 ng/ml or 13.0 ng/ml. HER2 ICD and ECD were overexpressed in tumor tissue of 19.8% and 6.9% of patients, respectively. Statistically significant associations were found between serum HER2 ECD levels and tissue expression of both HER2 ICD and ECD (p < .001; Fisher analysis). Moreover, strong concordances were found between serum HER2 ECD levels and tissue expression of HER2 ICD or ECD (cutoff 15.2 ng/ml: 80 and 92.5%, respectively). Our findings support a role for serum HER2 ECD as a surrogate marker of tissue HER2 status in primary BC, both for HER2 ICD or ECD expression.
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Affiliation(s)
- Aline S C Fabricio
- a Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine , Azienda ULSS 3 Serenissima, Regional Hospital , Venice , Italy
| | - Silvia Michilin
- a Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine , Azienda ULSS 3 Serenissima, Regional Hospital , Venice , Italy
| | - Matelda Zancan
- b Istituto Oncologico Veneto (IOV), IRCCS , Padua , Italy
| | - Valentina Agnolon
- a Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine , Azienda ULSS 3 Serenissima, Regional Hospital , Venice , Italy
| | - Lucia Peloso
- a Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine , Azienda ULSS 3 Serenissima, Regional Hospital , Venice , Italy
| | - Ruggero Dittadi
- c Laboratory Analysis Unit, Department of Clinical Pathology and Transfusion Medicine , Dell'Angelo Hospital, Azienda ULSS 3 Serenissima , Mestre-Venice , Italy
| | - Antonio Scapinello
- d Department of Pathology , General Regional Hospital, Azienda ULSS 2 Marca Trevigiana , Castelfranco Veneto , Italy
| | - Claudio Ceccarelli
- e Department of Specialized, Experimental, and Diagnostic Medicine - DIMES , University of Bologna, Policlinico S.Orsola-Malpighi , Bologna , Italy
| | - Massimo Gion
- a Regional Center for Biomarkers, Department of Clinical Pathology and Transfusion Medicine , Azienda ULSS 3 Serenissima, Regional Hospital , Venice , Italy
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Clerico A, Ripoli A, Masotti S, Musetti V, Aloe R, Dipalo M, Rizzardi S, Dittadi R, Carrozza C, Storti S, Belloni L, Perrone M, Fasano T, Canovi S, Correale M, Prontera C, Guiotto C, Cosseddu D, Migliardi M, Bernardini S. Evaluation of 99th percentile and reference change values of a high-sensitivity cTnI method: A multicenter study. Clin Chim Acta 2019; 493:156-161. [PMID: 30826369 DOI: 10.1016/j.cca.2019.02.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Italian Society of Clinical Biochemistry (SIBioC) and the Italian Section of the European Ligand Assay Society (ELAS) have recently promoted a multicenter study (Italian hs-cTnI Study) with the aim to accurately evaluate analytical performances and reference values of the most popular cTnI methods commercially available in Italy. The aim of this article is to report the results of the Italian hs-cTnI Study concerning the evaluation of the 99th percentile URL and reference change (RCV) values around the 99th URL of the Access cTnI method. MATERIALS AND METHODS Heparinized plasma samples were collected from 1306 healthy adult volunteers by 8 Italian clinical centers. Every center collected from 50 to 150 plasma samples from healthy adult subjects. All volunteers denied the presence of chronic or acute diseases and had normal values of routine laboratory tests (including creatinine, electrolytes, glucose and blood counts). An older cohort of 457 adult subjects (mean age 63.0 years; SD 8.1 years, minimum 47 years, maximum 86 years) underwent also ECG and cardiac imaging analysis in order to exclude the presence of asymptomatic cardiac disease. RESULTS AND CONCLUSIONS The results of the present study confirm that the Access hsTnI method using the DxI platform satisfies the two criteria required by international guidelines for high-sensitivity methods for cTn assay. Furthermore, the results of this study confirm that the calculation of the 99th percentile URL values are greatly affected not only by age and sex of the reference population, but also by the statistical approach used for calculation of cTnI distribution parameters.
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Affiliation(s)
- Aldo Clerico
- Laboratorio Clinico, Fondazione CNR-Regione Toscana, G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Andrea Ripoli
- Laboratorio Clinico, Fondazione CNR-Regione Toscana, G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Masotti
- Laboratorio Clinico, Fondazione CNR-Regione Toscana, G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Veronica Musetti
- Laboratorio Clinico, Fondazione CNR-Regione Toscana, G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Rosalia Aloe
- S. S. Dipartimentale Biochimica ad Elevata Automazione, Dipartimento Diagnostico Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Mariella Dipalo
- S. S. Dipartimentale Biochimica ad Elevata Automazione, Dipartimento Diagnostico Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Sara Rizzardi
- Azienda Socio-Sanitaria Territoriale di Cremona, UO Laboratorio analisi chimico cliniche e microbiologiche, Cremona, Italy
| | - Ruggero Dittadi
- UOC Medicina di Laboratorio, Ospedale dell'Angelo ULSS 3 Serenissima, Mestre, Italy
| | - Cinzia Carrozza
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, and Università Cattolica del Sacro Cuore, Roma, Italy
| | - Simona Storti
- Laboratorio Clinico, Fondazione CNR-Regione Toscana, G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Lucia Belloni
- Laboratorio di Autoimmunità, Allergologia e Biotecnologie Innovative, Azienda Unità Sanitaria Locale, IRCCS and Laboratorio Analisi Chimico-Cliniche ed Endocrinologia-ASMN, Azienda Ospedaliera di Reggio Emilia, Italy
| | - Marco Perrone
- Laboratorio Analisi Cliniche, Azienda Ospedaliera Universitaria Tor Vergata, Roma, Italy
| | - Tommaso Fasano
- Laboratorio di Autoimmunità, Allergologia e Biotecnologie Innovative, Azienda Unità Sanitaria Locale, IRCCS and Laboratorio Analisi Chimico-Cliniche ed Endocrinologia-ASMN, Azienda Ospedaliera di Reggio Emilia, Italy
| | - Simone Canovi
- Laboratorio di Autoimmunità, Allergologia e Biotecnologie Innovative, Azienda Unità Sanitaria Locale, IRCCS and Laboratorio Analisi Chimico-Cliniche ed Endocrinologia-ASMN, Azienda Ospedaliera di Reggio Emilia, Italy
| | - Mario Correale
- Unità di Patologia Clinica, IRCCS De Bellis, Castellana Grotte, e Laboratorio di Analisi Cliniche e Microbiologiche P.O. San Paolo - ASL Bari, Bari, Italy
| | - Concetta Prontera
- Laboratorio Clinico, Fondazione CNR-Regione Toscana, G. Monasterio e Scuola Superiore Sant'Anna, Pisa, Italy
| | - Cristina Guiotto
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | - Domenico Cosseddu
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | - Marco Migliardi
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | - Sergio Bernardini
- Laboratorio Analisi Cliniche, Azienda Ospedaliera Universitaria Tor Vergata, Roma, Italy
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18
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Clerico A, Belloni L, Carrozza C, Correale M, Dittadi R, Dotti C, Fortunato A, Vignati G, Zucchelli GC, Migliardi M. A Black Swan in clinical laboratory practice: the analytical error due to interferences in immunoassay methods. Clin Chem Lab Med 2018; 56:397-402. [PMID: 29220884 DOI: 10.1515/cclm-2017-0881] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/22/2017] [Indexed: 12/11/2022]
Abstract
It is well known that the results of immunoassay methods can be affected by specific or non-specific interferences, ranging from 0.4% to 4.0%. The presence of interference may greatly compromise the accuracy of immunoassay analyses causing an error in the measurement, producing false-positive or false-negative results. From a clinical point of view, these analytical errors may have serious implications for patient care because they can cause misdiagnosis or inappropriate treatment. Unfortunately, it is a very difficult task to identify the irregular analytical errors related to immunoassay methods because they are not detectable by normal laboratory quality control procedures, are reproducible within the test system, may be clinically plausible and are relatively rare. The first line of defense against erroneous results is to use in laboratory practice only immunoassay systems with the highest level of robustness against interference. The second line of defense is always taking into account the possibility of interference in immunoassay results. A correct approach should be addressed on identification of samples at high risk of interference. The attainment of this goal requires a critical review of the test result in relation to patient's clinical conditions and literature data, taking into account the analytical characteristics of the immunoassay system. The experts in immunoassay systems should make every effort to find some specific and reliable quality indicators for irregular analytical errors in order to better detect and monitor erroneous immunoassay results due to specific or non-specific interferences.
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Affiliation(s)
- Aldo Clerico
- Laboratory of Cardiovascular Endocrinology and Cell Biology, Department of Laboratory Medicine, Fondazione CNR Toscana G. Monasterio, Scuola Superiore Sant'Anna, Via Trieste 41, 56126 Pisa, Italy
| | - Lucia Belloni
- Dipartimento di Medicina di laboratorio, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Cinzia Carrozza
- Laboratorio Analisi 1, Fondazione Policlinico Universitario "A. Gemelli", Roma, Italy
| | - Mario Correale
- Clinical Pathology Unit, IRCCS De Bellis, Castellana Grotte, Bari, Italy
| | - Ruggero Dittadi
- Medicina di Laboratorio, Ospedale dell'Angelo ULSS 3 Serenissima, Mestre, Italy
| | - Claudio Dotti
- Dipartimento di Medicina di laboratorio, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Antonio Fortunato
- U.O.C. Patologia Clinica, ASUR Marche Area Vasta 5, Ascoli Piceno, Italy
| | | | | | - Marco Migliardi
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino, Torino, Italy
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Clerico A, Trenti T, Aloe R, Dittadi R, Rizzardi S, Migliardi M, Musa R, Dipalo M, Prontera C, Masotti S, Musetti V, Tozzoli R, Padoan A, Bagnasco M. A multicenter study for the evaluation of the reference interval for TSH in Italy (ELAS TSH Italian Study). ACTA ACUST UNITED AC 2018; 57:259-267. [DOI: 10.1515/cclm-2018-0541] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/18/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background
The aims of this study were: (1) to calculate reliable thyroid stimulating hormone (TSH) reference intervals using laboratory databases; (2) to evaluate the relationship between TSH, sex and age values in different large Italian populations.
Methods
The TSH values stored in the laboratory information system of clinical laboratories of four Italian city hospitals, including 146,801 TSH measurements (with the respective age and sex data of individuals) were taken in consideration. Assuming a log-normal distribution, to log-transformed TSH values were applied the Dixon’s iterative principle in order to exclude the outliers. At the end of this iterative process 142,821 log-transformed TSH results remained. The four clinical laboratories measured serum TSH concentrations using the same TSH immunoassay method (Access TSH 3rd IS, using UniCel DxI platform).
Results
The TSH reference interval calculated in the present study (0.362–5.280 mIU/L) is similar to that suggested by the manufacturer for the Access TSH 3rd IS assay (0.45–5.33 mIU/L). TSH values in females were significantly higher than in males (females: mean=2.06 mIU/L; standard deviation [SD]=1.26 mIU/L; n=101,243; males: mean=1.92 mIU/L; SD=1.19 mIU/L; n=41,578; p<0.0001). Moreover, a negative linear relationship was observed between TSH throughout all interval age values (from 0 to 105 years).
Conclusions
The results of the present multicenter study confirm that data mining techniques can be used to calculate clinically useful reference intervals for TSH. From a pathophysiological point of view, our results suggest that some Northern populations of Italy might still suffer some harmful effects on the thyroid gland due to mild to moderate iodine intake deficiency. Specific clinical trials are needed to confirm these results.
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Affiliation(s)
- Aldo Clerico
- Laboratory of Cardiovascular Endocrinology and Cell Biology, Department of Laboratory Medicine , Fondazione CNR-Regione Toscana Gabriele Monasterio, Scuola Superiore Sant’Anna , Via Trieste 41 , 56126 Pisa , Italy
| | - Tommaso Trenti
- Laboratorio di Patologia Clinica, Ospedale Pavullo nel Frignano , Modena , Italy
| | - Rosalia Aloe
- Dipartimento di Biochimica ad Elevata Automazione, Dipartimento Diagnostico , Azienda Ospedaliero-Universitaria di Parma , Parma , Italy
| | - Ruggero Dittadi
- U.O.C. Laboratorio Analisi, Ospedale dell’Angelo, AULSS3 Serenissima , Mestre, Venezia , Italy
| | - Sara Rizzardi
- Laboratorio Analisi Aziendale (SC), Azienda Socio-Sanitaria Territoriale di Cremona, Istituti Ospitalieri , Cremona , Italy
| | - Marco Migliardi
- S.C. Laboratorio Analisi, A.O. Ordine Mauriziano di Torino , Turin , Italy
| | - Roberta Musa
- Dipartimento di Biochimica ad Elevata Automazione, Dipartimento Diagnostico , Azienda Ospedaliero-Universitaria di Parma , Parma , Italy
| | - Mariella Dipalo
- Dipartimento di Biochimica ad Elevata Automazione, Dipartimento Diagnostico , Azienda Ospedaliero-Universitaria di Parma , Parma , Italy
| | - Concetta Prontera
- Fondazione CNR-Regione Toscana Gabriele Monasterio, Scuola Superiore Sant’Anna , Pisa , Italy
| | - Silvia Masotti
- Fondazione CNR-Regione Toscana Gabriele Monasterio, Scuola Superiore Sant’Anna , Pisa , Italy
| | - Veronica Musetti
- Fondazione CNR-Regione Toscana Gabriele Monasterio, Scuola Superiore Sant’Anna , Pisa , Italy
| | - Renato Tozzoli
- Clinical Pathology Laboratory, Department of Laboratory Medicine , Azienda per l’Assistenza Sanitaria n.5, Pordenone Hospital , Pordenone , Italy
| | - Andrea Padoan
- Department of Laboratory Medicine , University-Hospital , Padova , Italy
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20
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Gion M, Tremolada C, Mione R, della Palma P, Dittadi R, Zari C, Nosadini A, Castoro C, Ruol A, Peracchia A. Tumor Markers in Serum of Patients with Primary Squamous Cell Carcinoma of the Esophagus. Tumori 2018; 75:489-93. [PMID: 2603223 DOI: 10.1177/030089168907500519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Serum levels of several tumor markers were studied in 96 patients with untreated primary squamous cell carcinoma of the esophagus. Three markers specific for digestive tract malignancies - CEA, CA19.9 and CA50 - and two non organ specific indicators of malignancy - ferritin and TPA - were evaluated. Positivity rates of CAI9.9 and CA50 were very low (4.4 % and 8.6 % respectively); the markers were therefore considered ineffective in the disease. CEA, TPA and ferritin showed a fair positivity rate (27.1 %, 28.1 %, 33.7% respectively); CEA and TPA were directly related to clinical stage, CEA levels being significantly higher in stage IV than in stage III cases (p = 0.016). TPA preoperatory levels were also directly related to a lower survival probability (p = 0.004). CEA showed significantly lower levels in tumors of lower than in those of middle (p = 0.03) and upper esophagus (p = 0.004). TPA showed a similar behaviour with lower levels in tumors of lower than of middle esophagus (p = 0.03). These findings could be due to a bulky metabolism of tumor markers drained via portail vein in the liver. From our data the following conclusions may be drawn: 1) CEA and TPA may be useful in the staging of esophageal cancer as an ancillary tool to assess the extent of the disease; 2) tumor location is an important variable when evaluating blood levels of tumor markers in patients with esophageal cancer.
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Affiliation(s)
- M Gion
- Division of Radiotherapy, Regional General Hospital, USSL, Venice, Italy
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21
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Gion M, Tremolada C, Mione R, Dittadi R, Palma PD, Castoro C, Ruol A, Nosadini A, Peracchia A, Bruscagnin G. Tumor Markers in Squamous Cell Carcinoma of Esophagus: Immunometric Assay in Cytosol and Membrane Fraction. Int J Biol Markers 2018. [DOI: 10.1177/172460089000500102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), ferritin, and the monoclonal antibody-detected tumor-associated antigens CA19.9 and CA50 were measured by radioimmunoassay in tissue fractions of carcinoma and normal esophageal mucosa from 59 patients with untreated primary squamous cell carcinoma of the esophagus. Tumor markers were measured in cytosol (118 samples) and in a membrane-enriched fraction (32 samples). CEA, TPA and ferritin were detected in almost all the cytosol samples evaluated, CA19.9 and CA50 in 66% and 50% of cases respectively. Ferritin was significantly higher in carcinoma than in normal mucosa. The cytosol concentrations of CEA, TPA, CA19.9 and CA50 were not significantly different in carcinoma and normal tissue. Concentrations of CEA, CA19.9 and CA50 in the membrane fraction tended to be higher in normal tissue than in carcinoma, whereas the cytosol-to-membrane ratio was significantly higher in carcinoma. For CEA, CA19.9 and CA50, the phenotypic pattern of the malignant transformation seems to involve a different intracellular distribution rather than a quantitative change. No correlations were found between tissue and serum concentrations of the tumor markers, the former being related to the phenotypic characteristics of the tumor, the latter to the tumor burden.
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Affiliation(s)
- M. Gion
- Division of Radiotherapy and Nuclear Medicine, Regional General Hospital, ULSS 16, Venezia - Italy
| | - C. Tremolada
- 1st Surgery Department, University of Padova, Padova - Italy
| | - R. Mione
- Division of Radiotherapy and Nuclear Medicine, Regional General Hospital, ULSS 16, Venezia - Italy
| | - R. Dittadi
- Division of Radiotherapy and Nuclear Medicine, Regional General Hospital, ULSS 16, Venezia - Italy
| | - P. Della Palma
- Institute of Pathological Anatomy, University of Padova, Padova - Italy
| | - C. Castoro
- 1st Surgery Department, University of Padova, Padova - Italy
| | - A. Ruol
- 1st Surgery Department, University of Padova, Padova - Italy
| | - A. Nosadini
- 1st Surgery Department, University of Padova, Padova - Italy
| | - A. Peracchia
- 1st Surgery Department, University of Padova, Padova - Italy
| | - G. Bruscagnin
- Division of Radiotherapy and Nuclear Medicine, Regional General Hospital, ULSS 16, Venezia - Italy
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22
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Gion M, Mione R, Gatti C, Dittadi R, Leon A, Nascimben O, Pizzorno B, Bruscagnin G. Is Tissue Polypeptide Antigen Still a Useful Tumor Marker in Breast Carcinoma? Comparison with Ca15.3 and Mca. Tumori 2018; 76:360-4. [DOI: 10.1177/030089169007600411] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Massimo Gion
- Division of Radiotherapy, Nuclear Medicine, Oncology Center, General Regional Hospital, Venice
| | - Riccardo Mione
- Division of Radiotherapy, Nuclear Medicine, Oncology Center, General Regional Hospital, Venice
| | - Carlo Gatti
- Division of Radiotherapy, Nuclear Medicine, Oncology Center, General Regional Hospital, Venice
| | - Ruggero Dittadi
- Division of Radiotherapy, Nuclear Medicine, Oncology Center, General Regional Hospital, Venice
| | - Antonette Leon
- Division of Radiotherapy, Nuclear Medicine, Oncology Center, General Regional Hospital, Venice
| | - Ottorino Nascimben
- Service of Radiotherapy and Oncology Center, General Regional Hospital, Mestre
| | | | - Giuliano Bruscagnin
- Division of Radiotherapy, Nuclear Medicine, Oncology Center, General Regional Hospital, Venice
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Dittadi R, Biganzoli E, Boracchi P, Salbe C, Mione R, Gatti C, Gion M. Impact of Steroid Receptors, pS2 and Cathepsin D on the Outcome of N+ Postmenopausal Breast Cancer Patients Treated with Tamoxifen. Int J Biol Markers 2018. [DOI: 10.1177/172460089801300106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In spite of the complexity of the biological basis of the hormonal regulation of breast cancer, clinical studies tend to simplify the information by mainly categorizing continuous variables related to hormonal status and not considering the interactions between variables. The present study was planned to examine the presence of an interaction between cathepsin D (Cath-D) and pS2 in patients treated with adjuvant tamoxifen in a homogeneous subset of node-positive postmenopausal patients and to evaluate the contribution of the interaction to the predictive ability of the model. Steroid receptors (ER and PgR) were measured in cytosol using the dextran-coated charcoal method, while Cath-D and pS2 were determined using commercially available immunoradiometric assays. The prognostic role of each variable and their joint effect were investigated using a Cox regression model. Biological variables were analyzed as continuous and when their prognostic relationship did not seem linear, a restricted cubic spline regression smoothing approach was adopted. The logarithm of hazard showed a linear relationship with the log(ER), while it i) remained almost constant up to about 20 fmol/mg and subsequently decreased for PgR; ii) was almost constant up to about 50 pmol/mg and subsequently decreased for Cath-D; iii) decreased for increasing log(value) up to about 33 ng/mg and subsquently increased for pS2. In the multivariate analysis both PgR and the interaction between pS2 and Cath-D retained a significant prognostic role. For low values of pS2, the prognosis worsened with the increase in Cath-D levels and this relationship reversed for high values of pS2. From the results of the present study we can conclude that i) a significant interaction between Cath-D and pS2 was found in this case series; ii) the prognostic relationships should not be underestimated in clinical decision making; iii) a predictive score obtained considering the contribution of PgR, pS2 and Cath-D could be useful for clinical use.
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Affiliation(s)
- R. Dittadi
- Center for the Study of Biological Markers of Malignancy, Ospedale Civile, Venezia
| | - E. Biganzoli
- Division of Medical Statistics and Biometry, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano
| | - P. Boracchi
- Institute of Medical Statistics and Biometry, University of Milano
| | - C. Salbe
- Center for the Study of Biological Markers of Malignancy, Ospedale Civile, Venezia
| | - R. Mione
- Center for the Study of Biological Markers of Malignancy, Ospedale Civile, Venezia
| | - C. Gatti
- Division of Radiotherapy, Oncologic Center, Ospedale Civile, Venezia - Italy
| | - M. Gion
- Center for the Study of Biological Markers of Malignancy, Ospedale Civile, Venezia
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Pelizzola D, Gion M, Paradiso A, Dittadi R, Correale M, Mione R, Piffanelli A. Cathepsin D versus Other Prognostic Factors in Breast Cancer. Results and Controversies of a Multicenter Study on 2575 Cases. Int J Biol Markers 2018; 11:139-47. [PMID: 8915708 DOI: 10.1177/172460089601100301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was the survey of cathepsin D determination in a large group of patients enrolled at several centers, under the coordination of the Italian Committee for Quality Control in the Oncological Laboratory. Cathepsin D was measured with the same method-ology, under control of an intra and interlaboratory quality control program, in order to verify the comparability of cathepsin D results from different institutions and to analyze the frequency of cathepsin D positive cases in subgroups of patients stratified according to other prognostic parameters. This retrospective study included 2575 patients with primary breast cancer evaluat-ed in 10 institutions. Cytosol from tumor tissue was the substrate for biochemical cathepsin D, estrogen receptor and progesterone receptor determination, with an interlaboratory quality control survey provided by the E.O.R.T.C. Receptor Group and the Italian Committee for Quality Control in the Oncological Laboratory. The results of the present study can be summarized as follows: 1) Cathepsin D is independent of menopausal status; 2) In spite of standardization of tissue handling and assay methods, different results may be obtained by different institutions. It is therefore essential that each laboratory calculates its own positive/negative cutoff values prior to any routine clinical use of the parameter. This should be a serious consideration when a multicenter study is planned.
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Affiliation(s)
- D Pelizzola
- Cattedra di Medicina Nucleare, Università di Ferrara, Italy
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Gion M, Mione R, Dittadi R, Griggio L, Munegato G, Valsecchi M, Del Maschio O, Bruscagnin G. Carcinoembryonic Antigen, Ferritin, Tissue Polypeptide Antigen, and Ca15/3 in Breast Cancer: Relationship between Carcinoma and Normal Breast Tissue. Int J Biol Markers 2018; 1:33-8. [PMID: 3480322 DOI: 10.1177/172460088600100106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study of tumor markers in breast cancer tissue may supply information on the tumor's biological features and its clinical behaviour. Forty-nine primary breast cancer patients are evaluable to date. CEA, ferritin, TPA and CA15/3 were measured with radioimmu-nometric methods in the cytosol of carcinoma and normal tissue from the same breast. The concentrations of the four markers were higher in the tumor than in normal tissue in 42/49 cases for CEA, 47/49 for ferritin, 42/49 for TPA and in 24/29 for CA15/3. However, an overlap was found between carcinoma and normal tissue levels, particularly for CEA and TPA. We can conclude that the four substances studied may be markers of malignancy in breast carcinoma when nonmalignant breast tissue from the same patient is determined at the same time, whereas assays within a single, unknown breast tissue sample may be useful only in the case of ferritin and, partly, CA15/3.
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Affiliation(s)
- M Gion
- Laboratorio di Oncologia e Endocrinologia, Ospedali Civili Riuniti, Venezia
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27
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Gion M, Mione R, Dittadi R, Griggio L, Munegato G, Valescchi M, Del Maschio O, Fasan S, Bruscagnin G. Estrogen and Progesterone Receptors in Breast Carcinoma and in Nonmalignant Breast Tissue. Tumori 2018; 71:477-81. [PMID: 4060249 DOI: 10.1177/030089168507100511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since 1983 we have studied the relationship, in the same patient, between receptor status in breast carcinoma and in nonmalignant breast tissue. Fifty patients have been evaluated to date. The total unoccupied cytosol estrogen and progesterone receptors were determined by a dextran-coated charcoal method. In nonmalignant breast tissue we found a measurable receptor concentration above the sensitivity of the method in 62 % of cases for estrogen receptors and in 44 % of cases for progesterone receptors. No relationships were found between the receptor level of each tumor and that of the corresponding benign tissue. The data suggest that the levels of the receptors in the tumor and in the nonmalignant tissue are totally independent.
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Dittadi R, Zancan M, Perasole A, Gion M. Evaluation of HER-2/neu in Serum and Tissue of Primary and Metastatic Breast Cancer Patients using an Automated Enzyme Immunoassay. Int J Biol Markers 2018; 16:255-61. [PMID: 11820721 DOI: 10.1177/172460080101600406] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Serum HER-2/neu concentrations were evaluated in 172 healthy subjects, 176 primary and 55 metastatic breast cancer patients, employing a new automated assay (Bayer Immuno 1™ serum HER-2/neu). Using 13 ng/mL as the cutoff, abnormal HER-2/neu serum levels were found in 8% (14/176) of primary and 50.9% (28/55) of metastatic breast cancer patients. Both in primary and metastatic breast cancer a significant relationship was found with the stage of the disease when serum HER-2/neu was considered as a categorized variable (p=0.0003 and p=0.02, respectively), but not when it was taken as a continuous variable (p=0.247 and p=0.146, respectively). Moreover, we evaluated the correlation between Immuno 1™ HER-2/neu and Oncogene Research Products ELISA assay in 53 normal subjects, 46 primary and 34 metastatic breast cancer patients. The correlation was relatively good (p<0.0001), although substantial differences could be found in single cases. The Immuno 1™ assay was also evaluated for the first time in breast cancer tissue. The method, which showed good performance both in terms of imprecision and linearity, was used to measure HER-2/neu protein in 140 cytosol samples from primary breast cancer tissue and in homogenates from 40 matched cases. The correlation between the two matrixes was very close (p<0.0001). By contrast, no correlation was found between serum and matched cytosol (p=0.101) or ho-mogenate samples (p=0.511).
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Affiliation(s)
- R Dittadi
- Center for Biological Markers of Malignancy, General Regional Hospital, Venice Italy
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30
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Dittadi R, Meo S, Fabris F, Gasparini G, Contri D, Medici M, Gion M. Validation of Blood Collection Procedures for the Determination of Circulating Vascular Endothelial Growth Factor (VEGF) in Different Blood Compartments. Int J Biol Markers 2018. [DOI: 10.1177/172460080101600202] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aims of the study. Studies on circulating VEGF have reported mixed results, possibly due to a lack of standardization of the pre-analytical phase. The aim of our investigation was to standardize the sampling procedure for the determination of VEGF in different blood fractions. Basic procedures. We evaluated various clotting times for obtaining serum in 30 subjects, as well as different procedures for the preparation of plasma Edinburgh anticoagulant mixture (EDTA, PGE1, theophylline) and CTAD. VEGF was also assayed in lysed whole blood. In vitro platelet activation was monitored by measuring the levels of PF4. VEGF and PF4 were measured using commercially available enzyme-linked immunoassays. Main findings. Clotting time increased the release of VEGF, which reached a plateau between 2 and 4 hours. The percent increase of VEGF at 2 hours ranged from 118% to 4515% (median 327%) compared to samples centrifuged within 10 min from withdrawal. VEGF was not different and PF4 was very low or undetectable in Edinburgh plasma and CTAD plasma, while it was significantly higher in sodium citrate plasma. VEGF in CTAD plasma was not correlated with platelet count or leukocytes. Serum VEGF did not correlate with the leukocyte number, but it correlated significantly with the platelet count. Principal conclusions. The procedures for sample collection described above are highly standardized and easy to perform in a routine setting. We therefore suggest systematic evaluation of VEGF in CTAD plasma, in serum (clotting for 2 hours at room temperature) and in whole blood, until prospective controlled clinical studies will have clarified in which blood compartment(s) VEGF provides clinically relevant information.
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Affiliation(s)
- R. Dittadi
- Center for the Study of Biological Markers of Malignancy, Regional General Hospital ULSS 12, Venice
| | - S. Meo
- Center for the Study of Biological Markers of Malignancy, Regional General Hospital ULSS 12, Venice
| | - F. Fabris
- Department of Surgical and Medical Sciences, University of Padua, Padua
| | - G. Gasparini
- Division of Medical Oncology, Azienda Complesso Ospedaliero S. Filippo Neri, Rome
| | - D. Contri
- Central Laboratory, Regional General Hospital ULSS 12, Venice
| | - M. Medici
- Division of Medical Oncology, Regional General Hospital ULSS 12, Venice - Italy On behalf of the Quality Control Committee in Laboratory Oncology
| | - M. Gion
- Center for the Study of Biological Markers of Malignancy, Regional General Hospital ULSS 12, Venice
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Gion M, Barioli P, Ponti A, Torri V, Mione R, Dittadi R. How Tumor Markers are used in the Routine Follow-up of Breast and Colorectal Cancer. A Survey of 29 Italian Hospitals. Int J Biol Markers 2018. [DOI: 10.1177/172460089801300302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The impact of tumor markers on the outcome of several malignancies is still under debate. This relative uncertainty leads to a subjective approach to their use. Monitoring the use of tumor markers is a valuable tool to identify the need for educational policies. We conducted a survey to evaluate how tumor markers are routinely used in the follow-up of patients with breast, colorectal and ovarian carcinoma. The former two malignancies are considered in the present paper. We surveyed 35 Italian hospitals; 29 (83%, accounting for 26,622 hospital beds) filled in and returned the questionnaire. Overall, 467,361 tumor marker requests were scrutinized by the surveyed hospitals. We found a wide variability in the type and number of routinely used markers, the cutoff points chosen, and the clinical decisions taken on the basis of marker results. In addition, we observed a relative lack of communication between clinicians and clinical pathologists in around 50% of the surveyed hospitals. In these cases clinical information was not provided to the laboratory and methodological aspects were not communicated to clinicians. From the findings of the present study we conclude that the cooperation between clinicians and clinical pathologists must improve before guidelines for the use of tumor marker assays can be framed and the compliance with these guidelines can be checked. Request forms for tumor marker assays should therefore be designed to contain clinical information and the quality of filling in request forms with clinical data should be carefully monitored.
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Affiliation(s)
- M. Gion
- Center for the Study of Biological Markers of Malignancy and National Center for the Application of Biotechnologies in Oncology, Regional Hospital of Venezia, Venezia
| | - P. Barioli
- Center for the Study of Biological Markers of Malignancy and National Center for the Application of Biotechnologies in Oncology, Regional Hospital of Venezia, Venezia
| | - A. Ponti
- Epidemiology and Oncology Prevention Center for the Piedmont Region, Epidemiology Unit, Torino
| | - V. Torri
- Mario Negri Institute, Milano - Italy
| | - R. Mione
- Center for the Study of Biological Markers of Malignancy and National Center for the Application of Biotechnologies in Oncology, Regional Hospital of Venezia, Venezia
| | - R. Dittadi
- Center for the Study of Biological Markers of Malignancy and National Center for the Application of Biotechnologies in Oncology, Regional Hospital of Venezia, Venezia
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Salbe C, Trevisiol C, Ferruzzi E, Mancuso T, Nascimbeni R, Di Fabio F, Salerni B, Dittadi R. Molecular Detection of Codon 12 K-RAS Mutations in Circulating DNA from Serum of Colorectal Cancer Patients. Int J Biol Markers 2018; 15:300-7. [PMID: 11192825 DOI: 10.1177/172460080001500404] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Point mutations of the K-RAS gene at codon 12 are found in about 40% of cases with colorectal cancer. The diagnostic implications of the detection of these mutations and their clinical utility are still unclear. The aim of this study was to test both the feasibility of the detection of the mutated K-RAS gene in serum and its potential role in colorectal cancer detection and monitoring. Codon 12 K-RAS mutations were examined in DNA extracted from the serum of 35 patients with colorectal cancer and were compared with the K-RAS status in the corresponding primary tumor. Molecular detection was performed by the mutant-enriched PCR (ME-PCR) assay, a sensitive method capable of distinguishing a small quantity of mutated DNA in the presence of abundant wild-type DNA. The occurrence of mutations was compared with clinicopathological parameters as well as CEA and CA19.9 serum levels. We found codon 12 K-RAS mutations in the tissue of 13/35 (37%) patients. Serum mutations were detected in 5/13 (38.5%) patients with mutated K-RAS in the tissue. 26/35 (74%) patients showed an identical K-RAS pattern in tissue and serum. No codon 12 K-RAS alterations were found in serum samples of 22 patients with benign gastrointestinal diseases. Elevated serum CEA levels were detected in 16 patients, four of whom also presented serum RAS mutations. Our results confirm that K-RAS mutations can be found in circulating DNA extracted from serum samples of patients with colorectal cancer and show that there is a correspondence between serum and tissue K-RAS patterns.
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Affiliation(s)
- C Salbe
- Center for Biological Markers of Malignancy, Regional Hospital ULSS 12, Venice, Italy.
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Dittadi R, Franceschini R, Fortunato A, Zancan M, Barichello M, Tasca A, Giavarina D, Peloso L, Soffiati G, Gion M. Interchangeability and Diagnostic Accuracy of Two Assays for Total and Free Prostate-Specific Antigen: Two not Always Related Items. Int J Biol Markers 2018; 22:154-8. [PMID: 17549671 DOI: 10.1177/172460080702200209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The variation between different PSA assays seems to influence the interpretation of individual PSA values and the clinical decisions about prostate cancer. One reason for this variability could be the different reactivity of antibodies for the various molecular forms of serum PSA; as a result, samples containing the same amount of tPSA but different proportions of fPSA can produce very different values. In this study, serum samples were collected prospectively from 152 consecutive patients referred to 2 institutions (Regional Hospital, Venice, 90 subjects; San Bortolo Hospital, Vicenza, 62 subjects) for PSA elevation and/or symptoms. Serum samples were assessed according to the manufacturers’ instructions on the following 2 analyzers: the Immulite 2000 assay (Diagnostic Products Corporation, Los Angeles, USA), which measures tPSA and fPSA, and the ADVIA Centaur (Bayer Diagnostics, Tarrytown, USA), which assays tPSA and cPSA. cPSA values were transformed into fPSA by the equation fPSA=tPSA-cPSA. When taking Immulite tPSA and f/tPSA values as 100%, ADVIA Centaur values were 92.6% and 122%, respectively, which means that 20% of patients would be classified differently according to the traditional biopsy cutoff. In conclusion, there are considerable differences between the 2 methods, which could affect clinical decisions.
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Affiliation(s)
- R Dittadi
- Laboratory Analysis Unit, General Regional Hospital, AULSS 12, Mestre-Venice, Italy
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Boracchi P, Coradini D, Antolini L, Oriana S, Dittadi R, Gion M, Daidone M, Biganzoli E. A Prediction Model for Breast Cancer Recurrence after Adjuvant Hormone Therapy. Int J Biol Markers 2018; 23:199-206. [DOI: 10.1177/172460080802300401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hormone therapy with tamoxifen has long been the established adjuvant treatment for node-positive, estrogen–receptor-positive breast cancer in postmenopausal women. Since 30–40% of these patients fail to respond, reliable outcome prediction is necessary for successful treatment allocation. Using pathobiological variables (available in most clinical records: tumor size, nodal involvement, estrogen and progesterone receptor content) from 596 patients recruited at a comprehensive cancer center, we developed a prediction model which we validated in an independent cohort of 175 patients recruited at a general hospital. Calculated at 3 and 4 years of follow-up, the discrimination indices were 0.716 [confidence limits (CL) 0.641, 0.752] and 0.714 (CL 0.650, 0.750) for the training data, and 0.726 (CL 0.591, 0.769) and 0.677 (CL 0.580, 0.745) for the testing data. Waiting for more effective approaches from genomic and proteomic studies, a model based on consolidated pathobiological variables routinely assessed at relatively low costs may be considered as the reference for assessing the gain of new markers over traditional ones, thus substantially improving the conventional use of prognostic criteria.
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Affiliation(s)
- P. Boracchi
- Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milan
- Equally contributing Authors
| | - D. Coradini
- Unità Operativa Ricerca Traslazionale, Dipartimento Sperimentale, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
- Equally contributing Authors
| | - L. Antolini
- Unità di Statistica Medica e Biometria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S. Oriana
- Centro di Senologia, Casa di Cura Ambrosiana, Cesano Boscone, Milan
| | - R. Dittadi
- Centro Regionale Indicatori Biochimici di Tumore, Ospedale Civile, Asl 12, Venice - Italy
| | - M. Gion
- Centro Regionale Indicatori Biochimici di Tumore, Ospedale Civile, Asl 12, Venice - Italy
| | - M.G. Daidone
- Unità Operativa Ricerca Traslazionale, Dipartimento Sperimentale, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - E. Biganzoli
- Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milan
- Unità di Statistica Medica e Biometria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
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Meo S, Dittadi R, Peloso L, Gion M. The Prognostic Value of Vascular Endothelial Growth Factor, Urokinase Plasminogen Activator and Plasminogen Activator Inhibitor-1 in Node-Negative Breast Cancer. Int J Biol Markers 2018; 19:282-8. [PMID: 15646834 DOI: 10.1177/172460080401900405] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The vascular endothelial growth factor (VEGF) and the plasminogen activator system play an essential role in solid tumor angiogenesis and in tumor invasion and metastasis. In the present study we investigated the relationship between patient outcome and levels of VEGF, urokinase plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) in tumor cytosols of 196 node-negative primary invasive breast cancer patients who did not receive any adjuvant therapy. The median follow-up was 65 months. VEGF, uPA and PAI-1 were measured by commercially available enzyme-linked immunosorbent assays. Cox's univariate analysis showed that pT (p=0.0007), uPA (p=0.0156) and PAI-1 (p=0.0015) had a significant impact on relapse-free survival, whereas VEGF did not have any prognostic value (p=0.18). Bivariate analysis showed significant interactions between uPA and PAI-1 (p=0.0035) and between VEGF and PAI-1 (p=0.006). Our study confirms that uPA and PAI-1 cytosol levels can be considered as prognostic factors for relapse-free survival in node-negative breast cancer. Moreover, the interaction between VEGF and PAI-1 warrants further investigation into the relationship between the biomarkers of angiogenesis and those of the protease cascade.
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Affiliation(s)
- S Meo
- ABO Association, c/o Regional Center for the Study of Biological Markers of Malignancy, General Regional Hospital, ULSS 12, Venice, Italy
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Leon A, Torta M, Dittadi R, degli Uberti E, Ambrosio MR, Delle Fave G, De Braud F, Tomassetti P, Gion M, Dogliotti L. Comparison between Two Methods in the Determination of Circulating Chromogranin A in Neuroendocrine Tumors (NETs): Results of a Prospective Multicenter Observational Study. Int J Biol Markers 2018; 20:156-68. [PMID: 16240843 DOI: 10.1177/172460080502000303] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Several methods for analyzing CgA using either monoclonal or polyclonal antibodies have been developed, which differ in their diagnostic performance. The present paper describes the results of a prospective multicenter study aimed at comparing the clinical value of the two most widely used commercially available CgA assay kits in patients affected by neuroendocrine tumors (NETs). Two hundred sixty-one patients from 40 different centers and 99 healthy subjects were evaluated. CgA levels were measured with two different methods, a two-step immunoradiometric assay (IRMA) and an enzyme-linked immunosorbent assay (ELISA). CgA was measured centrally by two reference laboratories, one of which used IRMA and the other ELISA, and it was measured by the participating institutions with the method routinely used by each of them. The major findings of the present study were: (i) the two assays for the determination of CgA present good diagnostic performance; (ii) both assays are robust and guarantee comparable results when applied in different settings (central vs local laboratory); (iii) the negative/positive cutoff points (87 ng/mL for IRMA and 21.3 U/L for ELISA) were established according to standardized criteria; (iv) the results obtained with the two assays in basal clinical samples of patients affected by NETs show an apparently satisfactory correlation (rs=0.843, p<0.0001). However, a possibly clinically meaningful 36% discordance rate was found. These findings support the hypothesis that the two CgA kits might provide partially different information.
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Affiliation(s)
- A Leon
- ABO Association, c/o Regional Center for the Study of Biological Markers of Malignancy, General Regional Hospital, Venice, Italy.
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Dittadi R, Matteucci M, Meneghetti E, Ndreu R. Reassessment of the Access Testosterone chemiluminescence assay and comparison with LC-MS method. J Clin Lab Anal 2017. [PMID: 28643405 DOI: 10.1002/jcla.22286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM OF THE STUDY To reassess the imprecision and Limit of Quantitation, to evaluate the cross-reaction with dehydroepiandrosterone-sulfate (DHEAS), the accuracy toward liquid chromatography-mass spectrometry (LC-MS) and the reference interval of the Access Testosterone method, performed by DxI immunoassay platform (Beckman Coulter). MATERIAL AND METHODS Imprecision was evaluated testing six pool samples assayed in 20 different run using two reagents lots. The cross-reaction with DHEAS was studied both by a displacement curve and by spiking DHEAS standard in two serum samples with known amount of testosterone. The comparison with LC-MS was evaluated by Passing-Bablock analysis in 21 routine serum samples and 19 control samples from an External Quality Assurance (EQA) scheme. The reference interval was verified by an indirect estimation on 2445 male and 2838 female outpatients. RESULTS The imprecision study showed a coefficient of variation (CV) between 2.7% and 34.7% for serum pools from 16.3 and 0.27 nmol/L. The value of Limit of Quantitation at 20% CV was 0.53 nmol/L. The DHEAS showed a cross-reaction of 0.0074%. A comparison with LC-MS showed a trend toward a slight underestimation of immunoassay vs LC-MS (Passing-Bablock equations: DxI=-0.24+0.906 LCMS in serum samples and DxI=-0.299+0.981 LCMS in EQA samples). The verification of reference interval showed a 2.5th-97.5th percentile distribution of 6.6-24.3 nmol/L for male over 14 years and <0.5-2.78 nmol/L for female subjects, in accord with the reference intervals reported by the manufacturer. CONCLUSIONS The Access Testosterone method could be considered an adequately reliable tool for the testosterone measurement.
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Affiliation(s)
- Ruggero Dittadi
- U.O.C. Laboratorio Analisi, Laboratory Medicine Department, Ospedale dell'Angelo, ULSS 3 Serenissima, Mestre, Italy
| | | | - Elisa Meneghetti
- U.O.C. Laboratorio Analisi, Laboratory Medicine Department, Ospedale dell'Angelo, ULSS 3 Serenissima, Mestre, Italy
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Dittadi R, Rizzardi S, Masotti S, Prontera C, Ripoli A, Fortunato A, Alfano A, Carrozza C, Correale M, Gessoni G, Migliardi M, Zucchelli G, Clerico A. Multicenter evaluation of the new immunoassay method for TSH measurement using the automated DxI platform. Clin Chim Acta 2017; 468:105-110. [DOI: 10.1016/j.cca.2017.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 12/17/2022]
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Clerico A, Ripoli A, Fortunato A, Alfano A, Carrozza C, Correale M, Dittadi R, Gessoni G, Migliardi M, Rizzardi S, Prontera C, Masotti S, Zucchelli G, Guiotto C, Iacovazzi PA, Iervasi G. Harmonization protocols for TSH immunoassays: a multicenter study in Italy. ACTA ACUST UNITED AC 2017; 55:1722-1733. [DOI: 10.1515/cclm-2016-0899] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/25/2017] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Systematic difference between thyroid-stimulating hormone (TSH) immunoassays may produce misleading interpretation when samples of the same patients are measured with different methods. The study aims were to evaluate whether systematic differences are present among TSH immunoassays, and whether it is possible to obtain a better harmonization among TSH methods using results obtained in external quality assessment (EQA) schemes.Methods:Seven Italian clinical laboratories measured TSH in 745 serum samples of healthy subjects and patients with thyroid disorders. These samples were also re-measured by two reference laboratories of the study with the six TSH immunoassays most popular in Italy after 2 months of storage at −80 °C. Moreover, these data were compared to 53,823 TSH measurements, obtained by laboratories participant to 2012–2015 EQA annual cycles in 72 quality control samples (TSH concentrations from about 0.1 mIU/L to 18.0 mIU/L). TSH concentrations were recalibrated using a mathematical approach based on the principal component analysis (PCA).Results:Systematic differences were found between the most popular commercially available TSH immunoassays. TSH concentrations measured by the clinical laboratories were very closely correlated to those measured with the same method by reference laboratories after 2 months of storage at −80 °C. After recalibration using the PCA approach the variation of TSH values significantly decreased from a median pre-calibration value of 13.53% (10.79%–16.53%) to 9.63% (6.90%–13.21%) after recalibration.Conclusions:Our data suggest that EQA schemes are useful to improve harmonization among TSH immunoassays and also to produce some mathematical formulas, which can be used by clinicians to better compare TSH values measured with different methods.
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Dittadi R, Fiorin Damiani A, Olcese C. Evaluation of serum cortisol biological variation in the evening withdrawal. Clin Chem Lab Med 2017; 55:e285-e287. [DOI: 10.1515/cclm-2017-0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/03/2017] [Indexed: 11/15/2022]
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Dittadi R. Establishing objective analytical quality requirements in the IgE specific assay: a message in a bottle. Clin Chem Lab Med 2015; 53:e199-201. [PMID: 25803081 DOI: 10.1515/cclm-2015-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/23/2015] [Indexed: 11/15/2022]
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Dittadi R, Fabricio ASC, Michilin S, Gion M. Evaluation of a sex hormone-binding globulin automated chemiluminescent assay. Scandinavian Journal of Clinical and Laboratory Investigation 2013; 73:480-4. [DOI: 10.3109/00365513.2013.805807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dittadi R, Gion M. Re: Biological variation of neuroendocrine tumor markers chromogranin A and neuron-specific enolase. Clin Biochem 2013; 46:1145. [DOI: 10.1016/j.clinbiochem.2013.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 04/08/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
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Franceschini R, Trevisiol C, Dittadi R, Gion M. Tumour markers requesting pattern with regards to different organizational settings in Italy: a survey of hospital laboratories. Ann Clin Biochem 2009; 46:316-21. [DOI: 10.1258/acb.2009.008240] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Tumour markers are frequently used in clinical practice and the reason for ordering varies considerably and often seems to be inappropriate. We carried out a survey of Italian laboratories on their current pattern of use. Methods Forty-four laboratories located in health-care institutions with inpatient beds were surveyed about the organizational, clinical and methodological aspects of tumour markers ordering. Results Thirty-one laboratories (70%) filled in and returned the questionnaire. Overall, 977,786 tumour marker tests were scrutinized. The pattern of tumour marker use did not seem to be influenced by the institutional setting, by availability of oncology facilities or by adoption of clinical guidelines. In addition, the information flow from clinicians to the laboratory and vice versa was poor and informal. Conclusions Monitoring tumour marker pattern use can provide valuable information for health-care decision makers, highlighting potential inadequacies in laboratory services but also identifying problems in other areas of health-care delivery that could benefit from educational programmes.
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Affiliation(s)
- Roberta Franceschini
- Association ABO for the Application of Biotechnologies in Oncology c/o Centre for the Study of Biological Markers of Malignancy
| | - Chiara Trevisiol
- Association ABO for the Application of Biotechnologies in Oncology c/o Centre for the Study of Biological Markers of Malignancy
| | | | - Massimo Gion
- Association ABO for the Application of Biotechnologies in Oncology c/o Centre for the Study of Biological Markers of Malignancy
- Unit of Laboratory Medicine
- Centre for the Study of Biological Markers of Malignancy/Consortium Istituto Oncologico Veneto I.R.C.C.S., Regional Hospital, AULSS 12, Venice, Italy
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Affiliation(s)
- Ruggero Dittadi
- Laboratorio Analisi, Ospedale Umberto I, Via Circonvallazione 50, 30174Mestre
| | - Lucia Peloso
- ABO Association, c/o Center for the Study of Biological Markers of Malignancy, IOV IRCC – ULLS 12 Venice, Italia
| | - Massimo Gion
- Laboratorio Analisi, Ospedale Umberto I, Via Circonvallazione 50, 30174Mestre
- ABO Association, c/o Center for the Study of Biological Markers of Malignancy, IOV IRCC – ULLS 12 Venice, Italia
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Dittadi R, Gelisio P, Rossi L, Frigato F, Gion M. Biological variability evaluation and comparison of three different methods for C-peptide measurement. Clin Chem Lab Med 2008; 46:1480-2. [DOI: 10.1515/cclm.2008.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zancan M, Dittadi R, Scattoni V, Fandella A, Del Bianco P, Gion M. P21 Serum insulin-like growth factor-I and insulin-like growth factor binding protein-3 are not useful markers of prostate cancer. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(08)70099-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Verderio P, Dittadi R, Marubini E, Pizzamiglio S, Gion M, De Apollonia L, Paradiso A. An Italian program of External Quality Control for chromogranin A (CgA) assay: performance evaluation of CgA determination. ACTA ACUST UNITED AC 2007; 45:1244-50. [PMID: 17663633 DOI: 10.1515/cclm.2007.251] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chromogranin A (CgA) is an acidic glycoprotein produced by many neuroendocrine cells and neurons. Currently, two different methods for assaying CgA, immunoradiometric assay (IRMA) and enzyme-linked immunosorbent assay (ELISA), are widely used in routine practice. Within the framework of a Ministry of Health project, an External Quality Control program was developed to investigate the state of the art of CgA determination in Italy and to monitor the performance of laboratories carrying out this assay. This paper reports the results regarding laboratory performance. METHODS A total of 43 laboratories participated in this program, in which 21 used the ELISA method and 22 the IRMA method. Each laboratory received six samples, three aliquots of serum and three of plasma, at high, intermediate and low concentrations. The results provided by the two assay methods were analyzed separately using two statistical approaches, the principal component analysis and the control chart method. RESULTS For the IRMA method, questionable results for all samples were obtained by two laboratories, while in two other laboratories performance was questionable for only one sample. For the ELISA method, questionable performances were obtained in only one laboratory for the low and intermediate concentration samples, whereas in three laboratories performance was questionable for only one sample. Interestingly, the coefficients of variation increased approximately five-fold when shifting from the IRMA to the ELISA method. CONCLUSIONS This program demonstrated both the requirement and demand for external quality assessment of CgA assay.
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Affiliation(s)
- Paolo Verderio
- Unit of Medical Statistics and Biometry, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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