An intelligent decision support algorithm for diagnosis of colorectal cancer through serum tumor markers

Nowadays, a wide range of serum tumor markers can be applied in the diagnosis of colorectal cancer. There exists a wide variability in the type and number of routinely used markers so that, sometimes, patients may receive redundant or insufficient checks. Furthermore, the traditional single cutoff point also hinders the efficient utilization of the continuous check value of a tumor marker. In order to improve the diagnostic accuracy (DA) and decrease the cost, it is necessary to optimize the check combinations and exploit the check values fully. To this end, focusing on colorectal cancer (CRC), an artificial intelligent algorithm entitled DS-STM (diagnosis strategy of serum tumor makers) is developed in this paper. DS-STM can provide decision support for physicians on the usage of different tumor markers and diagnosis of colorectal cancer (CRC). The study demonstrates that, instead of five or more tumor markers, two markers are already enough for diagnosis for most CRC patients. The experimental study shows, compared to the traditional serial test, DS-STM can improve DA from 67.53% to 73.87% for the same validation dataset. In addition, a significant cost reduction can be achieved with the new developed diagnosis strategy.

Tumour markers requesting pattern with regards to different organizational settings in Italy: a survey of hospital laboratories

Background

Tumour markers are frequently used in clinical practice and the reason for ordering varies considerably and often seems to be inappropriate. We carried out a survey of Italian laboratories on their current pattern of use.

Methods

Forty-four laboratories located in health-care institutions with inpatient beds were surveyed about the organizational, clinical and methodological aspects of tumour markers ordering.

Results

Thirty-one laboratories (70%) filled in and returned the questionnaire. Overall, 977,786 tumour marker tests were scrutinized. The pattern of tumour marker use did not seem to be influenced by the institutional setting, by availability of oncology facilities or by adoption of clinical guidelines. In addition, the information flow from clinicians to the laboratory and vice versa was poor and informal.

Conclusions

Monitoring tumour marker pattern use can provide valuable information for health-care decision makers, highlighting potential inadequacies in laboratory services but also identifying problems in other areas of health-care delivery that could benefit from educational programmes.

Serum tumour markers: from quality control to total quality management

Since the first clinical use of tumour markers, quality assurance has been considered only in a restrictive manner, that is, as a surveillance of the analytical process. In other words, quality assessment was roughly viewed as a synonymous with quality control. This is not surprising, since tumour markers are almost exclusively assayed by radioimmunoassays, whose analytical performance were suboptimal in the 1970s. Furthermore, tumour marker concentrations in biological fluids were very low (in the ng range); in addition, primary standards were not available and dose-response curves were set up with conventional calibrators. Therefore, quality control programmes have become mandatory to restrict intra- and inter-laboratory variability.