Pathology society releases new tests, treatments physicians should reconsider

The American Society for Clinical Pathology has added five recommendations for laboratory treatments and tests that physicians and patients should question, according to a press release from the organization.

The test and treatments join a list of 10 previous recommendations, issued as part of the Choosing Wisely initiative, managed by the American Board of Internal Medicine (ABIM) and Consumer Reports.

“As ASCP continues to expand our recommendations, we expect to see increasing higher quality, appropriate care with lower costs, and more effective use of our medical laboratory resources and personnel,” Lee H. Hilborne, MD, MPH, FASCP, DLM(ASCP)CM, chair of ASCP’s Effective Test Utilization Subcommittee and a past president of ASCP, said in a press release. “Choosing Wisely aims to encourage clinician and patient conversations across all disciplines of medicine. ASCP’s work focuses on highlighting potentially unnecessary and sometimes harmful care in pathology and laboratory medicine.”

They recommended that physicians:

test for lipase when they suspect acute pancreatitis instead of amylase;
do not routinely biopsy the sentinel lymph node or perform other diagnostic tests when assessing for early, thin melanoma, as testing does not increase survival;
use breath tests or stool antigen when evaluating for H. pylori instead of serology;
do not request an expanded lipid panel, which includes nuclear magnetic resonance and particle sizing, when screening for cardiovascular disease; and
"do not perform fluorescence in situ hybridization (FISH) for myelodyplastic syndrome (MDS)-related abnormalities on bone marrow samples obtained for cytopenias when an adequate conventional karyotype is obtained."

The ASCP focused on these five tests, noting that "they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician."

“Conversations about what care patients truly need is a shared responsibility among all members of the health care team,” Richard J. Baron, MD, president and CEO of the ABIM Foundation, said in the release. “ASCP’s new Choosing Wisely list will help pathologists and laboratory professionals across the country engage in a dialogue about what care is best and what we can do to reduce waste and overuse in our health care system.”