New Pathology Testing Guidelines Unveiled

The Royal College of Pathologists of Australasia (RCPA) has unveiled new pathology testing guidelines to reduce inappropriate pathology testing in Australasia. 
The new pathology testing guidelines, will assist requesting doctors and patients to recognise the best way to harness important information provided by diagnostic testing.
Associate Professor Peter Stewart, President of the RCPA, says equal attention must  be applied to diagnostic testing and focusing on the inappropriate prescribing of medication.
“As medicine becomes more personalised, it inevitably becomes more complex, which can lead to confusion around the usefulness of some commonly used diagnostic tests. Based on current evidence, the RCPA has identified ten agreed areas to assist professionals and patients in this area,” says A/Prof Stewart.
“As a general rule, it is vital that each test has analytical validity, clinical validity and clinical utility and is cost effective.  Health practitioners must be well informed about a test’s characteristics to ensure the result or report from the test is valid and enhances their patient’s care.  Limited health resources must also be considered when conducting diagnostic tests,” says A/Prof Stewart.
The new testing guidelines proposed by the RCPA are aligned with successful campaigns which have already been implemented overseas, and draw on the collective knowledge of medical colleges and professional organisations to produce outlines of inappropriate practices in their respective fields.
The recommended guidelines aim to improve pathology requesting and address current inappropriate requesting trends.
Recommended guidelines for inappropriate pathology testing:

1. Do not perform surveillance urine cultures or treat asymptomatic bacteruria in older patients unless there are urinary tract signs and symptoms


2. Do not perform population based screening for Vitamin D deficiency


3. Do not perform PSA testing for prostate cancer screening in men with no symptoms
   and whose life expectancy is less than 10 years *


4. Do not perform routine pre-operative screening tests for low-risk surgery


5. Do not perform IgG4 allergy tests, total IgE (or indiscriminate batteries of IgE tests) in the investigation of allergy


6. Do not perform heavy metal tests for non-specific symptoms in the absence of exposure


7. Do not test for Lyme disease for non-specific symptoms in the absence of exposure (travel to endemic areas)


8. Do not perform serum tumour marker tests except for the monitoring of a cancer known to produce these markers


9. Do not routinely test and treat hyperlipidemia in those with a limited life expectancy


10. Do perform high sensitivity D-dimer assay in outpatients rather than imaging to exclude venous thrombo-embolism in patients with a low clinical probability

The RPCA acknowledges that the proposed guidelines require an ongoing review process and do not replace decision-making in individual circumstances. It must be recognised that the above guidelines reveal the current areas in need of training and consideration by those requesting tests.
*PSA is the only tumour marker supported for screening purposes.
References:
1. RCPA Position Statement:    Use and Interpretation of Vitamin D Testing

1. RCPA Position Statement:    Prostate specific antigen testing – age-related interpretation


2. RCPA Position Statement:    Diagnostic Laboratory Testing for  Borreliosis (‘Lyme Disease’
   or similar in Aust and NZ