Page 186 - Registrar Orientation Manual 2016

Reference:
Effective date:
2015
Expiry date:
2018
Page:
12 of 28
Title: Laboratory Testing Guidelines (DRAFT)
Type:
Clinical Guideline
Version:
01
Authorising initials:
CA 19-9 testing costs $18, and, with over 2,000 tests a year costs us $40,000/year. The DHB Shared Services Laboratory Test Referral Guidelines note:
CA 19-9 is elevated in patients with a wide range of malignancies including pancreatic, gastric, colorectal, hepatic and ovarian. It is also elevated in non- malignant disorders such as acute and chronic liver disease, acute and chronic pancreatitis, biliary diseases, diabetes and irritable bowel syndrome. It is most widely used in monitoring pancreatic cancer but is not sufficiently sensitive to be used in screening and not selective enough to be used in diagnosis. It may provide prognostic information at time of diagnosis.
It is indicated for:
 Patients with symptoms or signs associated with high suspicion of pancreatic cancer: progressive obstructive jaundice with weight loss and/or pain in the abdomen or mid back
 At diagnosis of pancreatic cancer to provide prognostic information
 After treatment of pancreatic cancer to monitor response and detect relapse
CA 15-3 testing costs $18, and, with over 1,000 tests a year costs us $20,000/year. The DHB Shared Services Laboratory Test Referral Guidelines note:
CA 15-3 is elevated in patients with a wide range of malignancies including breast, pancreatic, colorectal, lung, endometrial, liver and ovarian. It is also elevated in non-malignant disorders such as cirrhosis, benign breast disease and gynaecological disorders and pregnancy. It is most widely used in monitoring breast cancer patients after treatment although evidence this improves outcomes is weak. It does not have the required sensitivity or specificity to be used as a screening or diagnostic test. At diagnosis of breast cancer the level of CA 15-3 can provide information about the likelihood of metastases.
It is indicated:
 At diagnosis of breast cancer to provide prognostic information
 After treatment to monitor response and detect relapse
Vitamin D levels ($26)
The Choosing Wisely recommendations include the following:
Do not perform population based screening for Vitamin D deficiency. The DHB Shared Services Laboratory Test Referral Guidelines note: Testing is indicated in the following circumstances:
 Specific high risk groups for rickets/osteomalacia (cystic fibrosis, proven malabsorption),
 When ordered for the investigation of rickets/osteomalacia, osteoporosis/osteopenia,
disorders of calcium and phosphate metabolism, elevated ALP, hepatitis C,
 Refugees,
 Patients on anticonvulsants.
We recommend:
Testing for 1.25 Vitamin D is only indicated in patients with unexplained hypercalcemia who have a low PTH and in the evaluation of suspected hereditary causes of rickets