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Tumor Marker Ordering: Do Not Lose Control: A Prospective Clinical Trial
Simona Ferraro1, Roberta Mozzi2, Mauro Panteghini2
1From the Clinical Pathology Unit, 'Luigi Sacco' University Hospital, and Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy. ferraro.simona@hsacco.it.
American Journal of Clinical Pathology
|September 20, 2015
Summary
Inappropriate tumor marker (TM) ordering persists despite guidelines, often due to lack of education. Laboratory oversight can improve TM test efficacy and guide biomarker development.
Area of Science:
- Clinical Chemistry
- Laboratory Medicine
- Oncology Diagnostics
Background:
- Local guidelines for tumor marker (TM) ordering were introduced in secondary care settings.
- Evaluation of inappropriate TM ordering was conducted approximately six years post-guideline implementation.
Purpose of the Study:
- To assess the extent of inappropriate tumor marker (TM) ordering.
- To identify factors influencing clinicians' inappropriate TM requests.
Main Methods:
- A 21-month audit of requests involving more than two TMs was performed.
- Rejected requests constituted 3.6% of the audited TM orders.
- Carcinoembryonic antigen and carbohydrate antigen 19.9 were the most frequently and inappropriately requested TMs.
Main Results:
- Inappropriate TM requests were linked to a need for enhanced education on clinical applicability and limitations.
- Common motivations for inappropriate requests included nonspecific symptoms, incidental positive TM results, and avoidance of imaging procedures.
Conclusions:
- Real-time control of inappropriate TM requests by laboratory professionals can enhance clinical efficacy.
- Laboratory oversight may facilitate the introduction of new validated biomarkers.
