The gray zone

Think for a minute about the terms equivocal and indeterminate. Equivocal is defined as "of uncertain significance", and indeterminate is defined as "indefinite, uncertain". Now think of the context in which laboratory results are reported: either by using the exact words equivocal or indeterminate or cloaked in technical jargon (e.g., cytologic diagnoses "ASCUS" or "AGUS"). Clinicians expect (or at least want) laboratory results to be black or white (i.e., bimodally distributed), whereas laboratorians strive for the perfect shade of gray because of data that often are bimodal but overlapping. A consequence of this color war is "the gray zone" (often confused with the "twilight zone"), a noncommittal zone that leaves laboratorians and clinicians alike plenty of wiggle room, allowing us to interpret results on either side of the fence. This article examines the root causes of the gray zone, with several clinical examples of how it permeates laboratory interpretation.