1
|
Dorfman DM, Devitt KA, Cui W, Bashleben C, Naharro ECF, Hedley B, Hupp M, Karlon WJ, Murphy CE, Cherian S, Olteanu H, Seifert RP, Rosado FN, Linden MA. PCNEO, a New Proficiency Testing Program for Flow Cytometric Analysis of Plasma Cell Neoplasms From the College of American Pathologists Diagnostic Immunology and Flow Cytometry Committee. Arch Pathol Lab Med 2023:496203. [PMID: 37776247 DOI: 10.5858/arpa.2023-0035-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 10/02/2023]
Abstract
CONTEXT.— In 2018 the College of American Pathologists Diagnostic Immunology and Flow Cytometry Committee designed and implemented a new plasma cell neoplasia flow cytometry proficiency testing program-PCNEO-to allow clinical flow cytometry laboratories to monitor and assess their performance compared with a peer group. OBJECTIVE.— To report the results from the first 4 years of the PCNEO program. DESIGN.— Program participants were sent 2 sets of challenges per year, each including 1 wet challenge and 2 dry challenges, with associated clinical and laboratory findings. The wet challenges were composed of myeloma cell line specimens (with or without dilution in preserved whole blood) for flow cytometric analysis. The dry (paper) challenges were composed of clinical case summaries and images of flow cytometric test results from various flow cytometry laboratories of committee members. RESULTS.— A total of 116 to 145 laboratories from 17 countries enrolled in the proficiency testing program. For the wet challenges, almost all participants (97%-100%; cumulative, 98.2%) correctly identified the presence of neoplastic plasma cell populations based on flow cytometric analysis of undiluted myeloma cell lines. Slightly fewer participants (89.0%-97.4%; cumulative, 95.2%) correctly identified the presence of neoplastic plasma cell populations based on flow cytometric analysis of diluted myeloma cell lines (10% or 50% dilutions into peripheral blood) intended to better represent a typical clinical sample. There was generally agreement among 80% or more of participants for positive or negative staining for CD38, CD138, CD19, CD20, and surface and cytoplasmic κ and λ light chains. Similarly, 84% to 100% of participants were able to correctly identify the presence of neoplastic plasma cell populations in paper challenges, including the presence of small, neoplastic plasma cell populations (0.01%-5.0% clonal plasma cells), or the presence of nonneoplastic plasma cell populations (correctly identified by 91%-96% of participants). CONCLUSIONS.— Participant performance in the new proficiency testing program was excellent overall, with the vast majority of participants able to perform flow cytometric analysis and identify neoplastic plasma cell populations, and to identify small plasma cell clones or expanded populations of reactive plasma cells in dry challenge flow cytometry results. This program will allow laboratories to verify the accuracy of their testing program and test interpretations for the assessment of patients suspected of having a plasma cell neoplasm.
Collapse
Affiliation(s)
- David M Dorfman
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dorfman)
| | - Katherine A Devitt
- The Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Devitt)
| | - Wei Cui
- The Department of Pathology and Laboratory Medicine, University of Kansas Health System, Kansas City (Cui)
| | - Christine Bashleben
- Laboratory Improvement Programs, Surveys, College of American Pathologists, Northfield, Illinois (Bashleben)
| | - Elena C Frye Naharro
- The Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Naharro, Hupp, Linden)
| | - Benjamin Hedley
- The Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada (Hedley)
| | - Meghan Hupp
- The Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Naharro, Hupp, Linden)
| | - William J Karlon
- The Department of Laboratory Medicine, University of California, San Francisco (Karlon)
| | | | - Sindhu Cherian
- The Department of Laboratory Medicine and Pathology, University of Washington, Seattle (Cherian)
| | - Horatiu Olteanu
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Olteanu)
| | - Robert P Seifert
- The Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville (Seifert)
| | - Flavia N Rosado
- The Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Rosado)
| | - Michael A Linden
- The Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Naharro, Hupp, Linden)
| |
Collapse
|
2
|
Tebo AE, Willis R, Nwosu A, Bashleben C, Fox DA, Linden MA, Karlon WJ. Reporting and Establishment of Reference Intervals for Antiphospholipid Antibody Immunoassays: A Survey of Participants in the College of American Pathologists Proficiency Testing Program. Arch Pathol Lab Med 2023:496085. [PMID: 37756558 DOI: 10.5858/arpa.2023-0095-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT.— Misdiagnosis of antiphospholipid syndrome can occur owing to the wide diversity of antiphospholipid (aPL) assays and a lack of international calibrators and harmonized reference intervals. OBJECTIVE.— To assess laboratory practices regarding reporting and establishing reference intervals for immunoglobulin (Ig) G/IgM anti-cardiolipin (aCL) and anti-beta-2 glycoprotein I (anti-β2GPI) assays. DESIGN.— Supplemental questions related to reporting and establishing reference ranges for aPL assays were sent as part of the Antiphospholipid Antibody (ACL)-B 2019 College of American Pathologists (CAP) proficiency testing survey. The response rate and methods assessment details were determined, as well as qualitative and quantitative results for 3 test samples. RESULTS.— The number of participants reporting results for IgG aCL (n = 489), IgM aCL (n = 476), IgG anti-β2GPI (n = 354), and IgM anti-β2GPI (n = 331) varied by antibody type. The enzyme-linked immunosorbent assay (ELISA) (up to 58.6%, 260 of 444) was the most used method; others included multiplex (from 18.9% to 23.9%), fluorescence enzyme immunoassay (14.4%-17.6%), and chemiluminescence immunoassay (6.5%-9.0%). More respondents reported quantitative than qualitative results and manufacturer cutoff ranges were used by 92.9% and 94.2% of respondents for aCL and anti-β2GPI, respectively. Despite variation in the use of semiquantitative ranges, qualitative negative/positive reporting of the test samples achieved almost 100% consensus. Qualitative consensus was met in contrast to the wide range of quantitative results obtained for each analyte across different kits. CONCLUSIONS.— ELISA remains the most used method for detecting aPL antibodies with most laboratories reporting quantitative results based on manufacturers' suggested reference ranges. The categorization of quantitative results as equivocal, weak positive, or positive for responders using kits from the same manufacturer was variable.
Collapse
Affiliation(s)
- Anne E Tebo
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota (Tebo)
| | - Rohan Willis
- Antiphospholipid Standardization Laboratory, Division of Rheumatology, Department of Internal Medicine, University of Texas Medical Branch, Galveston (Willis)
| | - Ann Nwosu
- the Division of Biostatistics (Nwosu) and Laboratory Improvement Programs, Surveys (Bashleben), College of American Pathologists, Northfield, Illinois
| | - Christine Bashleben
- the Division of Biostatistics (Nwosu) and Laboratory Improvement Programs, Surveys (Bashleben), College of American Pathologists, Northfield, Illinois
| | - David A Fox
- the Division of Rheumatology, Clinical Autoimmunity Center of Excellence, University of Michigan Medical School, Ann Arbor (Fox)
| | - Michael A Linden
- the Division of Hematopathology, Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis (Linden)
| | - William J Karlon
- the Departments of Pathology and Laboratory Medicine, University of California, San Francisco (Karlon)
| |
Collapse
|
3
|
Tacker DH, Bashleben C, Long TC, Theel ES, Knight V, Kadkhoda K, Rhoads DD, Linden MA, Fink SL. Interlaboratory Agreement of Anti-Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Serologic Assays in the Expedited College of American Pathologists Proficiency Testing Program. Arch Pathol Lab Med 2021; 145:536-542. [PMID: 33461214 DOI: 10.5858/arpa.2020-0811-sa] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 01/30/2023]
Abstract
CONTEXT.— Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a recently emerged, currently pandemic virus, and the etiologic agent of coronavirus disease 2019 (COVID-19). Clinical testing for antibodies to SARS-CoV-2 has rapidly become widespread, but data regarding the interlaboratory performance of these serologic assays are limited. OBJECTIVE.— To describe the development and initial results of the College of American Pathologists (CAP) SARS-CoV-2 Serology Survey. DESIGN.— Members from the CAP Microbiology and Diagnostic Immunology and Flow Cytometry Committees formed a working group to support development of a new proficiency testing survey for anti-SARS-CoV-2 antibody assays. Supplemental questions in the survey assessed the state of SARS-CoV-2 serologic testing among participating laboratories as of July 2020. Results were analyzed for agreement by immunoglobulin (Ig) isotype tested, assay manufacturer, and methodology. RESULTS.— A total of 4125 qualitative results were received from 1110 laboratories participating in the first survey. Qualitative agreement for assays measuring anti-SARS-CoV-2 total antibodies or IgG was greater than 90% for all 3 samples in the survey. Qualitative agreement for IgM and IgA for the negative sample was greater than 95%, but lacked consensus for the other 2 samples. CONCLUSIONS.— These initial data suggest overall excellent agreement and comparable performance for most qualitative anti-SARS-CoV-2 IgG and total antibody assays across all participating clinical laboratories, regardless of specific target antigen or assay methodology.
Collapse
Affiliation(s)
- Danyel H Tacker
- The Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, Morgantown (Tacker)
| | - Christine Bashleben
- Laboratory Improvement Programs, Surveys (Bashleben), College of American Pathologists, Northfield, Illinois
| | - Thomas C Long
- Department of Biostatistics (Long), College of American Pathologists, Northfield, Illinois
| | - Elitza S Theel
- The Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota (Theel)
| | - Vijaya Knight
- The Department of Pediatrics, Section of Allergy and Immunology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora (Knight)
| | - Kamran Kadkhoda
- Immunopathology Laboratory, Robert Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Kadkhoda)
| | - Daniel D Rhoads
- The Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio (Rhoads)
| | - Michael A Linden
- The Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis (Linden)
| | - Susan L Fink
- The Department of Laboratory Medicine and Pathology, University of Washington, Seattle (Fink)
| |
Collapse
|
4
|
Hupp MM, Bashleben C, Cardinali JL, Dorfman DM, Karlon W, Keeney M, Leith C, Long T, Murphy CE, Pillai V, Rosado FN, Seegmiller AC, Linden MA. Participation in the College of American Pathologists Laboratory Accreditation Program Decreases Variability in B-Lymphoblastic Leukemia and Plasma Cell Myeloma Flow Cytometric Minimal Residual Disease Testing: A Follow-up Survey. Arch Pathol Lab Med 2021; 145:336-342. [PMID: 32886757 DOI: 10.5858/arpa.2019-0493-cp] [Citation(s) in RCA: 1] [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] [Accepted: 05/15/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Minimal residual disease (MRD) testing by flow cytometry is ubiquitous in hematolymphoid neoplasm monitoring, especially B-lymphoblastic leukemia (B-ALL), for which it provides predictive information and guides management. Major heterogeneity was identified in 2014. Subsequently, new Flow Cytometry Checklist items required documentation of the sensitivity determination method and required lower level of detection (LLOD) inclusion in final reports. This study assesses Laboratory Accreditation Program (LAP) participation and new checklist items' impact on flow cytometry MRD testing. OBJECTIVES.— To survey flow cytometry laboratories about MRD testing for B-ALL and plasma cell myeloma. In particular, enumerate the laboratories performing MRD testing, the proportion performing assays with very low LLODs, and implementation of new checklist items. DESIGN.— Supplemental questions were distributed in the 2017-A mailing to 548 flow cytometry laboratories subscribed to the College of American Pathologists FL3 Proficiency Testing Survey (Flow Cytometry-Immunophenotypic Characterization of Leukemia/Lymphoma). RESULTS.— The percentage of laboratories performing MRD studies has significantly decreased since 2014. Wide ranges of LLOD and collection event numbers were reported for B-ALL and plasma cell myeloma. Most laboratories determine LLOD by using dilutional studies and include it in final reports; a higher proportion of LAP participants used these practices than nonparticipants. CONCLUSIONS.— Several MRD testing aspects vary among laboratories receiving FL3 Proficiency Testing materials. After the survey in 2014, new checklist items were implemented. As compared to 2014, fewer laboratories are performing MRD studies. While LLOD remains heterogeneous, a high proportion of LAP subscribers follow the new checklist requirements and, overall, target LLOD recommendations from disease-specific working groups are met.
Collapse
Affiliation(s)
- Meghan M Hupp
- From the Division of Hematopathology, Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis (Hupp, Linden)
| | | | - Jolene L Cardinali
- Special Hematology, Hartford Hospital, Hartford, Connecticut (Cardinali)
| | - David M Dorfman
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dorfman)
| | - William Karlon
- The Departments of Pathology and Laboratory Medicine, University of California, San Francisco (Karlon)
| | - Michael Keeney
- London Health Sciences Centre, Lawson Health Research Institute, London, Ontario, Canada (Keeney)
| | - Catherine Leith
- The Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison (Leith)
| | - Thomas Long
- College of American Pathologists, Northfield, Illinois (Bashleben, Long)
| | | | - Vinodh Pillai
- the Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Pillai)
| | - Flavia N Rosado
- The Department of Pathology and Laboratory Services, University of Texas Southwestern Medical Center, Dallas (Rosado)
| | - Adam C Seegmiller
- The Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Seegmiller)
| | - Michael A Linden
- From the Division of Hematopathology, Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis (Hupp, Linden)
| |
Collapse
|
5
|
Wener MH, Fink S, Bashleben C, Sindelar S, Linden MA. Long-Term Variability in Immunofluorescence Titer of Antibodies to Nuclear Antigens Observed in Clinical Laboratory Proficiency Testing Surveys. Arch Pathol Lab Med 2020; 145:937-942. [PMID: 33373439 DOI: 10.5858/arpa.2020-0419-cp] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Presence of antibodies to nuclear antigens (ANAs) above a threshold titer is an important diagnostic feature of several autoimmune diseases, yet titers reported vary between laboratories. Proficiency survey results can help clarify factors contributing to the variability. OBJECTIVE.— To determine the contribution of HEp-2 ANA kits from different manufacturers to the variation in titers, and assess whether the differences between kits are consistent over the long term. DESIGN.— HEp-2 ANA titers reported by laboratories participating in the external quality assessment proficiency testing surveys conducted by the College of American Pathologists between 2008 and 2018 were analyzed. The ANA titers reported for each specimen were ranked according to the kits being used by testing laboratories, and the statistical significance of the differences was determined. RESULTS.— The ANA titer results were strongly influenced by the HEp-2 ANA kit used (P < .001). During the 11 years studied, the rank order of the ANA titer for each kit relative to the other kits was remarkably consistent. The rank of ANA titer for individual ANA patterns observed for each kit was similar to the overall rank of that kit. CONCLUSIONS.— Variability in ANA titers was strongly associated with the kits used, and the differences between kits were quite consistent during the 11 years studied. Because the variability is not random, it has the potential to be managed by harmonizing kits, which could lead to improved consistency in reporting ANA titers.
Collapse
Affiliation(s)
- Mark H Wener
- From the Departments of Laboratory Medicine and Pathology (Wener, Fink).,and Medicine (Wener), University of Washington, Seattle
| | - Susan Fink
- From the Departments of Laboratory Medicine and Pathology (Wener, Fink)
| | - Christine Bashleben
- Laboratory Improvement Programs, Surveys (Bashleben, Sindelar), College of American Pathologists, Northfield, Illinois
| | - Stephanie Sindelar
- Laboratory Improvement Programs, Surveys (Bashleben, Sindelar), College of American Pathologists, Northfield, Illinois
| | - Michael A Linden
- and the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Linden)
| |
Collapse
|
6
|
Willrich MAV, Long TA, Bashleben C, Fink SL, Rudolf JW, Peterson D, Wener MH, Baltaro RJ, Genzen JR, Ansari MQ, Rhoads DD, Linden MA. Performance of perpendicular drop versus tangent skimming gating of M-protein in proficiency testing challenges. Clin Chem Lab Med 2020; 59:e19-e22. [PMID: 32628626 DOI: 10.1515/cclm-2020-0697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/15/2020] [Indexed: 11/15/2022]
Affiliation(s)
| | - Thomas A Long
- College of American Pathologists, Northfield, IL, USA
| | | | - Susan L Fink
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Joseph W Rudolf
- University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Daniel Peterson
- University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Mark H Wener
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | | | | | | | | | | |
Collapse
|
7
|
Naides SJ, Genzen JR, Abel G, Bashleben C, Ansari MQ. Antinuclear Antibodies Testing Method Variability: A Survey of Participants in the College of American Pathologists' Proficiency Testing Program. J Rheumatol 2020; 47:1768-1773. [PMID: 32173652 DOI: 10.3899/jrheum.190933] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study was conducted to determine the spectrum of laboratory practices in antinuclear antibody (ANA) test target, performance, and result reporting. METHODS A questionnaire on ANA testing was distributed by the Diagnostic Immunology and Flow Cytometry Committee of the College of American Pathologists (CAP) to laboratories participating in the 2016 CAP ANA proficiency survey. RESULTS Of 5847 survey kits distributed, 1206 (21%) responded. ANA screening method varied: 55% indirect immunofluorescence assay, 21% ELISA, 12% multibead immunoassay, and 18% other methods. The name of the test indicated the method used in only 32% of laboratories; only 39% stated the method used on the report. Of 644 laboratories, 80% used HEp-2 cell substrate, 18% HEp-2000 (HEp-2 cell line engineered to overexpress SSA antigen, Ro60), and 2% other. Slides were prepared manually (67%) or on an automated platform (33%) and examined by direct microscopy (84%) or images captured by an automated platform (16%). Only 50% reported a positive result at the customary 1:40 dilution. Titer was reported to endpoint routinely by 43%, only upon request by 23%, or never by 35%. Of the laboratories, 8% did not report dual patterns. Of those reporting multiple patterns, 23% did not report a titer with each pattern. CONCLUSION ANA methodology and practice, and test naming and reporting varies significantly between laboratories. Lack of uniformity in testing and reporting practice and lack of transparency in communicating the testing method may misdirect clinicians in their management of patients.
Collapse
Affiliation(s)
- Stanley J Naides
- S.J. Naides, MD, Scientific Affairs, Euroimmun US, a PerkinElmer company, Mountain Lakes, New Jersey, and Diagnostic Immunology and Flow Cytometry Committee, College of American Pathologists, Northfield, Illinois;
| | - Jonathan R Genzen
- J.R. Genzen, MD, PhD, Diagnostic Immunology and Flow Cytometry Committee, College of American Pathologists, Northfield, Illinois, and Pathology, University of Utah / ARUP Laboratories, Salt Lake City, Utah
| | - Gyorgy Abel
- G. Abel, MD, PhD, Diagnostic Immunology and Flow Cytometry Committee, College of American Pathologists, Northfield, Illinois, and Laboratory Medicine and Pathology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Christine Bashleben
- C. Bashleben, MT, Diagnostic Immunology and Flow Cytometry Committee, College of American Pathologists, Northfield, Illinois
| | - M Qasim Ansari
- M.Q. Ansari, MD, Diagnostic Immunology and Flow Cytometry Committee, College of American Pathologists, Northfield, Illinois, and Pathology and Laboratory Medicine, Louis Stokes VAMC, Cleveland, Ohio, USA
| |
Collapse
|
8
|
Genzen JR, Murray DL, Abel G, Meng QH, Baltaro RJ, Rhoads DD, Delgado JC, Souers RJ, Bashleben C, Keren DF, Ansari MQ. Screening and Diagnosis of Monoclonal Gammopathies: An International Survey of Laboratory Practice. Arch Pathol Lab Med 2017; 142:507-515. [DOI: 10.5858/arpa.2017-0128-cp] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Serum tests used for the screening and diagnosis of monoclonal gammopathies include serum protein electrophoresis (SPE; agarose gel or capillary zone), immunofixation (IFE) and immunosubtraction capillary electrophoresis, serum free light chains, quantitative immunoglobulins, and heavy/light–chain combinations. Urine protein electrophoresis and urine IFE may also be used to identify Bence-Jones proteinuria.
Objective.—
To assess current laboratory practice for monoclonal gammopathy testing.
Design.—
In April 2016, a voluntary questionnaire was distributed to 923 laboratories participating in a protein electrophoresis proficiency testing survey.
Results.—
Seven hundred seventy-four laboratories from 38 countries and regions completed the questionnaire (83.9% response rate; 774 of 923). The majority of participants (68.6%; 520 of 758) used agarose gel electrophoresis as their SPE method, whereas 31.4% (238 of 758) used capillary zone electrophoresis. The most common test approaches used in screening were SPE with reflex to IFE/immunosubtraction capillary electrophoresis (39.3%; 299 of 760); SPE only (19.1%; 145 of 760); SPE and IFE or immunosubtraction capillary electrophoresis (13.9%; 106 of 760); and SPE with IFE, serum free light chain, and quantitative immunoglobulins (11.8%; 90 of 760). Only 39.8% (305 of 767) of laboratories offered panel testing for ordering convenience. Although SPE was used by most laboratories in diagnosing new cases of myeloma, when laboratories reported the primary test used to follow patients with monoclonal gammopathy, only 55.7% (403 of 724) chose SPE, with the next most common selections being IFE (18.9%; 137 of 724), serum free light chain (11.7%; 85 of 724), and immunosubtraction capillary electrophoresis (2.1%; 15 of 724).
Conclusions.—
Ordering and testing practices for the screening and diagnosis of monoclonal gammopathy vary widely across laboratories. Improving utilization management and report content, as well as recognition and development of laboratory-directed testing guidelines, may serve to enhance the clinical value of testing.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Mohammad Q. Ansari
- From the Department of Pathology, University of Utah, Salt Lake City, and ARUP Laboratories, Salt Lake City, Utah (Drs Genzen and Delgado); the Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota (Dr Murray); the Department of Laboratory Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts (Dr Abel); the Department of Laboratory Medicine, University of Texas MD An
| |
Collapse
|
9
|
Meier FA, Souers RJ, Howanitz PJ, Tworek JA, Perrotta PL, Nakhleh RE, Karcher DS, Bashleben C, Darcy TP, Schifman RB, Jones BA. Seven Q-Tracks monitors of laboratory quality drive general performance improvement: experience from the College of American Pathologists Q-Tracks program 1999-2011. Arch Pathol Lab Med 2015; 139:762-75. [PMID: 26030245 DOI: 10.5858/arpa.2014-0090-cp] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Many production systems employ standardized statistical monitors that measure defect rates and cycle times, as indices of performance quality. Clinical laboratory testing, a system that produces test results, is amenable to such monitoring. OBJECTIVE To demonstrate patterns in clinical laboratory testing defect rates and cycle time using 7 College of American Pathologists Q-Tracks program monitors. DESIGN Subscribers measured monthly rates of outpatient order-entry errors, identification band defects, and specimen rejections; median troponin order-to-report cycle times and rates of STAT test receipt-to-report turnaround time outliers; and critical values reporting event defects, and corrected reports. From these submissions Q-Tracks program staff produced quarterly and annual reports. These charted each subscriber's performance relative to other participating laboratories and aggregate and subgroup performance over time, dividing participants into best and median performers and performers with the most room to improve. Each monitor's patterns of change present percentile distributions of subscribers' performance in relation to monitoring durations and numbers of participating subscribers. Changes over time in defect frequencies and the cycle duration quantify effects on performance of monitor participation. RESULTS All monitors showed significant decreases in defect rates as the 7 monitors ran variously for 6, 6, 7, 11, 12, 13, and 13 years. The most striking decreases occurred among performers who initially had the most room to improve and among subscribers who participated the longest. All 7 monitors registered significant improvement. Participation effects improved between 0.85% and 5.1% per quarter of participation. CONCLUSIONS Using statistical quality measures, collecting data monthly, and receiving reports quarterly and yearly, subscribers to a comparative monitoring program documented significant decreases in defect rates and shortening of a cycle time for 6 to 13 years in all 7 ongoing clinical laboratory quality monitors.
Collapse
Affiliation(s)
- Frederick A Meier
- From the Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan (Drs Meier and Jones); the Departments of Biostatistics (Ms Souers) and Surveys (Ms Bashleben), College of American Pathologists, Northfield, Illinois; the Department of Pathology, State University of New York, Brooklyn (Dr Howanitz); the Department of Pathology, St Joseph Mercy Hospital, Ypsilanti, Michigan (Dr Tworek); the Department of Pathology, West Virginia University Health Sciences Center, Morgantown (Dr Perrotta); the Department of Pathology, Mayo Clinic, Jacksonville, Florida (Dr Nakhleh); George Washington University Medical Center, Washington, DC (Dr Karcher); Clinical Laboratories, University of Wisconsin Hospitals and Clinics, Madison (Dr Darcy); and Diagnostic Service Line, Southern Arizona Veterans Administration Health Care Systems, Tucson (Dr Schifman)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Booth CN, Bashleben C, Filomena CA, Means MM, Wasserman PG, Souers RJ, Henry MR. Monitoring and ordering practices for human papillomavirus in cervical cytology: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference working group 5. Arch Pathol Lab Med 2013; 137:214-9. [PMID: 23368863 DOI: 10.5858/arpa.2012-0114-cp] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT The association of certain types of human papillomavirus with cervical carcinoma is well established. Human papillomavirus testing is now routinely used to screen for cervical carcinoma and precursor lesions of the cervix (cotesting and reflex testing) and these results are considered in patient triage and management. OBJECTIVE To provide information about current laboratory practices in human papillomavirus testing and consensus best practice statements based on results from the College of American Pathologists' laboratory-based survey funded by the Centers for Disease Control and Prevention. DESIGN The College of American Pathologists submitted a paper-based survey to 1245 laboratories in the United States. After review of the initial results, follow-up Web-based survey results, and a literature review by an expert working group, consensus best practice statements were constructed by working group members for presentation at a national consensus conference. These best practice statements were discussed and then voted upon by conference participants. RESULTS A total of 525 laboratories responded to survey questions about human papillomavirus ordering and monitoring practices, whereas 546 responded to the overall survey. In most laboratories (87.6%), the high-risk human papillomavirus test is ordered as a reflex test by providers. A minority of laboratories (11.9%) routinely bundle low- and high-risk human papillomavirus tests. Most laboratories (84.4%) do not limit testing in patients with atypical squamous cells to women older than 20 years. More than half of laboratories (53.3%) monitor human papillomavirus positive rates in Papanicolaou tests with atypical squamous cells of undetermined significance. CONCLUSIONS It is not appropriate for laboratories to offer low-risk human papillomavirus testing for any clinical circumstance in gynecologic cytology. Laboratories should not order human papillomavirus testing to resolve diagnostic discrepancies. It is a valuable broad measure of laboratory quality to monitor the human papillomavirus-positive rates in Papanicolaou tests with atypical squamous cells.
Collapse
Affiliation(s)
- Christine N Booth
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
| | | | | | | | | | | | | |
Collapse
|