Page 185 - Registrar Orientation Manual 2016

Reference:
Effective date:
2015
Expiry date:
2018
Page:
11 of 28
Title: Laboratory Testing Guidelines (DRAFT)
Type:
Clinical Guideline
Version:
01
Authorising initials:
Troponin ($9)
Troponin elevation has limited specificity and is common in very sick patients. We recommend:
Do not do a Troponin unless an acute coronary syndrome is strongly suspected or needs to be excluded.
Tumour markers (CEA is $15, CA 125 $18, CA19-9 $18, PSA $10)
The Choosing Wisely recommendations include the following:
Do not perform serum tumour marker tests except for the monitoring of a cancer known to produce these markers.
Do not perform PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than 7 years.
The DHB Shared Services Laboratory Test Referral Guidelines have recommendations for a number of specific tumour markers. They note tumour markers are not indicated for
 screening of an asymptomatic low risk population,
 investigation of non-specific symptoms, when the probability of malignancy is low,
 investigation of other suspected malignancies.
CEA testing costs $15, and, with over 6,000 tests a year costs us more than $100,000/year.
The DHB Shared Services Laboratory Test Referral Guidelines note:
CEA is elevated in patients with a wide range of malignancies including colorectal, gastric, pancreatic, lung, breast, and medullary thyroid cancer. It is also elevated in non-malignant disorders; ulcerative colitis, pancreatitis, cirrhosis, pleural inflammation, chronic renal failure and in smokers. It is most widely used in monitoring colorectal cancer (CRC) but is not sufficiently sensitive to be used in screening and not selective enough to be used in diagnosis.
It is indicated in/for:
 Patients with symptoms or signs associated with high suspicion of CRC
 At diagnosis of CRC (to provide prognostic information)
 After treatment of CRC (to monitor response and detect relapse)
 In some cases of breast cancer to monitor response after treatment and detect relapse
CA125 testing costs $18, and, with 3,000 tests a year, costs us more than $50,000/year. The DHB Shared Services Laboratory Test Referral Guidelines note:
CA 125 is elevated in patients with a wide range of malignancies including ovarian, pancreatic, lung, breast, endometrial, non-Hodgkin's Lymphoma and hepatocellular. It is also elevated in non- malignant disorders such as acute and chronic liver diseases, acute and chronic pancreatitis, rheumatoid arthritis, ulcerative colitis, endometriosis, menstruation, non-malignant ascites and pleural effusions, and SLE. It is most widely used in monitoring serous epithelial ovarian cancer and it may provide prognostic information. Its role in screening is still under evaluation but it may be useful in diagnosis in patients with high probability of ovarian cancer
It is indicated in/for:
 Patients with features associated with high suspicion of ovarian cancer: persistent continuous or worsening unexplained abdominal or urinary symptoms and pelvic mass.
 Case detection in patients at high risk of familial ovarian cancer.
 At diagnosis of ovarian cancer to provide prognostic information
 After treatment to monitor response and detect relapse