In this study, we evaluated the extent of inappropriate tumor marker (TM) ordering in a secondary care setting, approximately 6 years after the introduction of local guidelines, and we identified the main factors potentially influencing clinicians when performing an inappropriate TM request.
For this purpose, we regularly checked all requests containing more than two TMs. During the 21-month audit, the rate of rejected requests amounted to 3.6%. Several of those were performed for diagnostic purposes. The most frequent and inappropriately requested TMs were carcinoembryonic antigen and carbohydrate antigen 19.9.
The inappropriateness of requests appeared to be linked to the need for more education and knowledge on their clinical applicability and limitations. The clinical motivation was generally associated with patients displaying nonspecific signs/symptoms (ie, weight loss with worsening general conditions), having an incidentally positive result to some recently performed TM tests, or being tested by a TM to avoid more expensive diagnostic imaging procedures.
Our data show that real-time control and management of inappropriate requests by laboratory professionals may be relevant to increase the clinical efficacy of TM testing and useful in perspective to drive the introduction of new validated biomarkers.
在这项研究中，我们评估了当地指南介绍公布大约6年之后二级保健机构中肿瘤标志物（tumor marker ，TM）检查不合理的程度，并且确定了可能影响临床医生进行不合理TM申请的主要因素。为此，我们常规审查了所有包含2项TM以上的申请。在为期21个月的审查过程当中，拒绝检查申请的百分率达3.6%。那些申请中一部分是出于诊断目的。所申请的最常见和最不合理的TM就是癌胚抗原（CEA）和糖类抗原19.9。申请的不合理性似乎与在TM的临床适用性和局限性方面需要更多的教育和知识相关。临床的动机一般与以下因素有关：患者表现出非特异性体征/症状（即体重减轻伴全身状况恶化），一些最近进行的TM检查出现了偶尔的阳性结果，或是进行一项TM检测以避免更昂贵的诊断性成像程序。我们的数据显示，实验室专业人员对不合理申请的实时控制和处理可以增加TM检查的临床有效性，并且有助于推动新型有效生物标志物的引进。