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Lorde N, Elgharably A, Kalaria T. Impact of Variation between Assays and Reference Intervals in the Diagnosis of Endocrine Disorders. Diagnostics (Basel) 2023; 13:3453. [PMID: 37998589 PMCID: PMC10670091 DOI: 10.3390/diagnostics13223453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
Method-related variations in the measurement of hormones and the reference intervals used in the clinical laboratory can have a significant, but often under-appreciated, impact on the diagnosis and management of endocrine disorders. This variation in laboratory practice has the potential to lead to an errant approach to patient care and thus could cause harm. It may also be the source of confusion or result in excessive or inadequate investigation. It is important that laboratory professionals and clinicians know about these impacts, their sources, and how to detect and mitigate them when they do arise. In this review article, we describe the historical and scientific context from which inconsistency in the clinical laboratory arises. Examples from the published literature of the impact of the method, reference interval, and clinical decision threshold-related discordances on the assessment and monitoring of various endocrine disorders are discussed to illustrate the sources, causes, and effects of this variability. Its potential impact on the evaluation of growth hormone deficiency and excess, thyroid and parathyroid disorders, hyperandrogenism, hypogonadism, glucocorticoid excess and deficiency, and diabetes mellitus is elaborated. Strategies for assessment and mitigation of the discordance are discussed. The clinical laboratory has a responsibility to recognise and address these issues, and although a lot has been accomplished in this area already, there remains more to be done.
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Affiliation(s)
- Nathan Lorde
- Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK; (A.E.); (T.K.)
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Zhou X, Liu Z, Ma Y, Zhang C, Wu Y. A mathematical algorithm to harmonize measurements for thyroid-stimulating hormone between instruments. Clin Chim Acta 2023; 548:117513. [PMID: 37562523 DOI: 10.1016/j.cca.2023.117513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Thyroid-stimulating hormone (TSH) is measured differently between diagnostic units using different devices, which makes cross-comparisons challenging. Here, we have developed a mathematical algorithm to harmonize TSH measurements between 2 instruments, the Abbott ISR2000 and the Siemens ADVIA Centaur XP. METHODS Applying the principle of the maximum allowable error between the standard curve and real signal values, the minimum number of comparison samples required for TSH hormone detection was calculated for both instruments. Next, a mathematical algorithm describing the relationship between TSH standard curves from both instruments was established. The algorithm was then tested on sample measurements from both instruments, with signals transformed to Siemens ADVIA Centuar XP-type data. Finally, test results were assessed where the relative error was RESULTS Before conversion, the mean percentage error between the TSH results of samples measured on both instruments was 23.20% (>1/2 TEa). After algorithmic transformation, the average percentage error was reduced to 7.93% (<1/2 TEa). CONCLUSIONS Our algorithm enables TSH measurements across different instruments to be comparable, and provides a method to harmonize TSH data between laboratories that utilize different instrumentation.
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Affiliation(s)
- Xin Zhou
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China; Jintang First People's Hospital, Chengdu 610400, China
| | - Zaishuan Liu
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yining Ma
- College of Mathematics of Sichuan University, Chengdu 610065, China
| | - Chongwei Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yongkang Wu
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China; Jintang First People's Hospital, Chengdu 610400, China.
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Kalaria T, Fenn J, Sanders A, Yates A, Duff C, Ashby H, Mohammed P, Ford C, Gama R. The Diagnosis of Normocalcaemic Hyperparathyroidism is Strikingly Dissimilar Using Different Commercial Laboratory Assays. Horm Metab Res 2022; 54:429-434. [PMID: 35835142 DOI: 10.1055/a-1856-4900] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We assessed the impact of intact parathyroid hormone (iPTH) and adjusted calcium analyses on Abbott, Roche and Siemens analytical platforms in the diagnosis of normocalcaemic primary hyperparathyroidism (NCPHPT). These assays are used by over 85% of clinical laboratories in the UK. Over five months, consecutive serum samples from outpatients with NCPHPT in the laboratory with Abbott assays were identified, aliquoted and stored at -80°C. Frozen aliquots were transported monthly to the other two laboratories. After thawing, samples were mixed and analysed immediately for calcium, albumin and iPTH in the laboratories with Abbott, Roche and Siemens analytical platforms. Adjusted calcium was calculated using the equation used in the respective laboratory. Diagnostic concordance of iPTH and adjusted calcium were assessed using manufacturer-provided assay-specific reference intervals and the pathology harmony reference interval respectively. Fifty-five patients with NCPHPT were identified using Abbott assays. Of these, 16 (29.1%) and 11 (20.0%) had NCPHPT, 9 (16.4%) and 13 (23.6%) had hypercalcaemic primary hyperparathyroidism, and 30 (54.6%) and 31 (56.4%) patients had normal results when analysed in laboratories with Roche and Siemens assays, respectively. The diagnosis of NCPHPT was strikingly different depending on the commercial assay used. There is a pressing need for iPTH assay harmonisation and robust reference intervals. Reference intervals may become invalid if an assay drifts, as exemplified by adjusted calcium in this study.
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Affiliation(s)
- Tejas Kalaria
- Clinical Biochemistry, New Cross Hospital, Black Country Pathology Services, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
| | - Jonathan Fenn
- Clinical Biochemistry, New Cross Hospital, Black Country Pathology Services, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
| | - Anna Sanders
- Clinical Biochemistry, Russells Hall Hospital, Black Country Pathology Services, Dudley, United Kingdom of Great Britain and Northern Ireland
| | - Alexandra Yates
- Clinical Biochemistry, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
| | - Christopher Duff
- Clinical Biochemistry, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
- School of Primary, Community & Social Care, Faculty of Medicine & Health Sciences, Keele University, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
| | - Helen Ashby
- Clinical Biochemistry, Russells Hall Hospital, Black Country Pathology Services, Dudley, United Kingdom of Great Britain and Northern Ireland
| | - Pervaz Mohammed
- Clinical Biochemistry, Russells Hall Hospital, Black Country Pathology Services, Dudley, United Kingdom of Great Britain and Northern Ireland
| | - Clare Ford
- Clinical Biochemistry, New Cross Hospital, Black Country Pathology Services, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
| | - Rousseau Gama
- Clinical Biochemistry, New Cross Hospital, Black Country Pathology Services, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
- School of Medicine and Clinical Practice, University of Wolverhampton, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
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Clinical concordance assessment should be an integral component of laboratory method comparison studies: A regression transference of routine clinical data approach. Clin Biochem 2022; 103:25-28. [DOI: 10.1016/j.clinbiochem.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
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Kalaria T, Fenn J, Sharrod-Cole H, Sanders A, Ford C, Gama R. Samples spiked with pituitary-derived thyroid-stimulating hormone may disguise the extent of differences between thyroid-stimulating hormone assays. Ann Clin Biochem 2021; 58:638-645. [PMID: 34533384 DOI: 10.1177/00045632211042560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A large discordance in the diagnosis and potential management of hypothyroidism using Abbott and Roche thyroid assays has been reported recently. The difference in Abbott and Roche thyroid-stimulating hormone (TSH) results in these studies was larger than anticipated from the external quality assessment (EQA) reports. METHODS Abbott and Roche TSH method means in UK NEQAS for thyroid hormones distributions 430 to 454 were compared against the amount of TSH spiked. A TSH deplete serum pool was spiked with various concentrations of pooled high TSH serum and 3rd WHO International Standard for TSH (WHO-IS). Four serum pools with TSH close to clinical decision limits were spiked with two concentrations of WHO-IS. RESULTS On review of EQA data, median (IQR) Roche: Abbott TSH ratio was lower (p < 0.001) in 48 pools spiked with TSH (1.11 (1.07-1.16)) compared to 41 pools not spiked (1.29 (1.25-1.31)) and the decrease was proportionate to the contribution of spiked TSH to total TSH in the samples (ρ=-0.908, p < 0.001). In spiking experiments, the relationship of Roche and Abbott TSH was different in TSH deplete pool spiked with WHO-IS (RocheTSH=1.13*AbbottTSH-0.52) and high TSH serum (RocheTSH=1.43*AbbottTSH-0.50), respectively. The Roche: Abbott TSH ratio decreased and the method agreement improved on spiking serum pools with WHO-IS. CONCLUSION Abbott and Roche TSH assays are not in harmony in human serum samples but the agreement was better in samples spiked with WHO-IS which contains pituitary-derived TSH. Use of pituitary-derived TSH spiked samples, such as provided by EQA schemes, may mask clinically significant between-assay differences.
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Affiliation(s)
- Tejas Kalaria
- New Cross Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Jonathan Fenn
- New Cross Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Hayley Sharrod-Cole
- New Cross Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Anna Sanders
- Russells Hall Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Dudley, UK
| | - Clare Ford
- New Cross Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Rousseau Gama
- New Cross Hospital, Black Country Pathology Services, 592016The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Medicine and Clinical Practice, University of Wolverhampton, Wolverhampton, UK
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Kalaria T, Sanders A, Fenn J, Buch HN, Ford C, Ashby HL, Mohammed P, Gama R. Different thyroid assays may greatly affect diagnosis and management of hypothyroidism. BMJ 2021; 373:n1458. [PMID: 34108149 DOI: 10.1136/bmj.n1458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Tejas Kalaria
- Clinical Biochemistry, New Cross Hospital, Black Country Pathology Services, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Anna Sanders
- Clinical Biochemistry, Russells Hall Hospital, Black Country Pathology Services, Royal Wolverhampton NHS Trust, Dudley, UK
| | - Jonathan Fenn
- Clinical Biochemistry, New Cross Hospital, Black Country Pathology Services, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Harit N Buch
- Endocrinology, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Clare Ford
- Clinical Biochemistry, New Cross Hospital, Black Country Pathology Services, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Helen L Ashby
- Clinical Biochemistry, Russells Hall Hospital, Black Country Pathology Services, Royal Wolverhampton NHS Trust, Dudley, UK
| | - Pervaz Mohammed
- Clinical Biochemistry, Russells Hall Hospital, Black Country Pathology Services, Royal Wolverhampton NHS Trust, Dudley, UK
| | - Rousseau Gama
- Clinical Biochemistry, New Cross Hospital, Black Country Pathology Services, Royal Wolverhampton NHS Trust, Wolverhampton, UK
- School of Medicine and Clinical Practice, University of Wolverhampton, Wolverhampton, UK
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