Joseph Watine
Are Laboratory Investigations Recommended in Current Medical
Practice Guidelines Supported by Available Evidence?
It has been suggested that evidence-based laboratory
medicine (EBLM) could help to improve the pertinence
and accuracy of medical guidelines. In order to demonstrate
this, we have used an EBLM approach (i.e. a systematic
review) to examine three recently published
guidelines that gave quite conflicting recommendations
regarding the use of laboratory variables in the
management of primary non-small cell lung cancer patients.
In recommending the routine measurement of
serum albumin, and, to a lesser extent, that of serum
calcium in the pre-therapeutic prognostic evaluation
of the advanced disease, the American Thoracic
Society and the European Respiratory Society were
probably correct with regard to calcium but perhaps
mistaken regarding albumin. Some of the recommendations
of the European Group on Tumour Markers
regarding the usefulness of routine measurements of
tumour markers (carcinoembryonic antigen (CEA),
cancer antigen 125 (CA 125), tissue-polypeptide antigen
(TPA)) in the pre- and/or post-therapeutic prognostic
evaluation can also be criticised. In addition, the
latter society as well as the Société de Pneumologie de
Langue Française did not even try to list laboratory
variables, others than tumour markers, that would be
useful to stratify patients participating in clinical trials
(i.e. lactate dehydrogenase (LDH), albumin, calcium,
blood cell count, etc.), and the laboratory variables
listed by the two former societies were probably not
the right ones in this context: in particular LDH and
tumour markers (fragments of cytokeratin 19 (Cyfra
21–1), tissue-polypeptide-specific antigen (TPS), neuron-specific enolase (NSE)) were not mentioned. Most,
if not all of these discrepancies in the current medical
practice guidelines might have been avoided had an
EBLM approach been used by the authors.
Clinical Chemical Laboratory Medicine, Walter de Gruyter
Print ISSN: 1434-6621
Volume: 40, 04/2002
Pages: 252 - 255
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