When should labs be added for interpretation?

When to Add Labs for Interpretation

Laboratory results should be added for interpretation when they require expert analysis to guide clinical decision-making, particularly when the results impact morbidity, mortality, and quality of life outcomes.

Key Scenarios for Adding Laboratory Interpretation

Complex Testing Scenarios

• Laboratory results should be added for interpretation when they involve complex testing methodologies such as next-generation sequencing (NGS) in cancer diagnostics, where key information needs to be highlighted in a simple, understandable format 1
• Molecular test results should be integrated into electronic medical records to ensure accessibility and facilitate linking of multiple biomarker tests 1

When Clinical Context Is Essential

• Laboratory professionals should work closely with clinicians when test interpretation requires understanding of assay methods and potential interferences 1
• Multidisciplinary tumor boards (MDTBs) or molecular tumor boards (MTBs) are recommended when complex genetic variants are present to provide clinical context to genetic information 1

For Standardized Phenotype-Genotype Correlation

• Laboratory results should be added when standardized phenotypic data collection is needed using Human Phenotype Ontology (HPO) terminology to ensure consistent interpretation 1
• Scheduled follow-up appointments enable capturing evolving phenotypes to refine variant interpretation over time 1

For Specialized Testing

• Lupus anticoagulant (LA) test results should always be reported with quantitative results and an interpretative comment indicating presence/absence of LA, as many clinicians may not understand complex testing procedures 1
• HbA1c results should be reported with calculated estimated average glucose (eAG) to eliminate the need for providers to perform calculations themselves 1

Best Practices for Laboratory Result Interpretation

Clear Communication of Results

• Reports should highlight actionable alterations and include a summary on the first page with clarity in variant annotation and interpretation 1
• Laboratory results should be reported with quantitative values and interpretative comments, avoiding terms like "borderline" or "dubious" 1

Addressing Technical Limitations

• Laboratories should communicate directly with ordering clinicians if technical test limitations may influence clinical interpretation 1
• Each laboratory should clearly state their policy regarding completion of missing sequences or classes of variation relevant to the indication for ordering genomic tests 1

Contextualizing Results

• Antiphospholipid antibody test results should be interpreted in the context of a full laboratory profile, as isolated positivity may be less clinically significant 1
• For iron deficiency anemia diagnosis, ferritin results should be interpreted using a cut-off of 45 ng/mL rather than 15 ng/mL 1

Handling Special Circumstances

• For patients on anticoagulants, interpretation of LA testing requires special consideration, with recommendations to perform testing 1-2 weeks after discontinuation of vitamin K antagonists or when INR is less than 1.5 1
• For genomic testing, variant interpretations (particularly variants of uncertain significance) should be periodically re-evaluated as new gene-disease and variant-disease associations are discovered 1

Pitfalls to Avoid

• Avoid reporting laboratory results without interpretative comments, as clinicians may not be aware of the significance of complex testing procedures 1
• Avoid grading positivity of anticardiolipin and anti-β2-glycoprotein I antibodies into low-medium-high categories without method-specific adaptations 1
• Avoid interpreting laboratory results in isolation without considering the clinical context, especially for complex genetic testing 1
• Be cautious when interpreting results from tests performed during acute events, as acute-phase reactants may affect test results 1

By following these guidelines, laboratory results can be effectively integrated into clinical decision-making, ultimately improving patient outcomes related to morbidity, mortality, and quality of life.