Should I appeal the cancellation of the Mulmar (Molecular) testing that was ordered for this patient by the hematopathologist at the lab?

Appealing Cancellation of Molecular Testing

You should not appeal the hematopathologist's decision to cancel the Mulmar (molecular) testing, as laboratory professionals have the authority and expertise to determine which tests are medically necessary based on clinical and specimen criteria.

Understanding Laboratory Test Cancellations

Laboratory professionals, particularly hematopathologists, have specialized training to determine when molecular testing is appropriate. Their decision to cancel testing is typically based on several factors:

1. Pre-analytical considerations:

   • Specimen quality or quantity issues
   • Improper collection or handling
   • Timing of collection relative to treatment

2. Clinical appropriateness:

   • Whether the test results would impact clinical management
   • If preliminary findings make the test unnecessary
   • If other testing would be more appropriate

3. Resource stewardship:

   • Cost-effectiveness considerations
   • Appropriate utilization of specialized testing

When Molecular Testing Cancellations Occur

The European LeukemiaNet guidelines specifically address appropriate testing scenarios in hematologic malignancies 1. For example:

• Molecular testing like BCR::ABL1 TKD mutation screening should only be performed when BCR::ABL1 mRNA levels are ≥0.1% IS, as defined by ELN failure or warning criteria
• Testing is not indicated in patients with BCR::ABL1 IS < 0.1%
• Testing is not indicated at diagnosis before starting TKI treatment

Similarly, other molecular tests have specific indications and contraindications that hematopathologists are trained to evaluate.

Alternative Approaches

Rather than appealing the cancellation, consider these more productive approaches:

1. Request clarification: Ask the hematopathologist to explain their rationale for cancelling the test

2. Provide additional clinical information: If you believe the hematopathologist lacked key clinical details that would justify the testing, provide this information

3. Discuss alternative testing: Inquire about other testing approaches that might provide the needed clinical information

4. Consider timing: If the test was cancelled due to timing issues (e.g., too soon after treatment), ask when retesting would be appropriate

Laboratory Stewardship

Laboratory professionals play a critical role in test stewardship, helping to ensure that the right test is performed on the right patient at the right time 2, 3. This includes cancelling tests that are unlikely to provide clinically useful information or that may lead to false or misleading results.

The hematopathologist's decision to cancel testing likely reflects their professional judgment about the appropriateness of the test in this specific clinical scenario, based on established guidelines and best practices in laboratory medicine.