Utilization Review of Paraneoplastic Neurological Syndrome Antibody Screening Panels: Experience at a Tertiary Academic Health Center

Abstract

Pathology departments play a pivotal role in managing laboratory test utilization in healthcare, and inappropriate resource deployment can contribute to unnecessary healthcare costs. Here we share our experience reviewing a send-out test and implementing a utilization strategy. Antibody testing is often considered in the workup for patients with unexplained paraneoplastic syndrome-like neurological presentations. It has been unclear how helpful these antibody tests are. The goal of study is to evaluate diagnostic utility of antibody screening panel results in patients suspicious for paraneoplastic neurological syndrome and possibly underlying occult malignancy. We retrospectively reviewed the paraneoplastic neurological syndrome antibody test results. The positive predictive value and negative predictive value were calculated. The proportion of the antibody screening results were compared between groups with and without tumor with 2-sided χ2 test statistics. In total 348 panels were sent to 2 reference laboratories. From ARUP (Associated Regional and University Pathologists; Salt Lake City, Utah), 2 out of 232 screening panels yielded positive results (0.86%) and from the Mayo Clinic (Rochester, Minnesota), 26 out of 116 screening panels yielded positive results (22.4%). The overall positive predictive value was 3.57% (1/28) and the overall negative predictive value was 91.2% (292/320). There were no statistically significant differences between the antibody screening test results between the 2 groups with and without tumor. We found the diagnostic utility and yield for the paraneoplastic antibody panel to be low. Following a multidisciplinary team review of the study results, the pathology department has implemented several new utilization strategies.