In October 2017, the American Society for Clinical Pathology (ASCP) outlined 20 “do nots” as part of the Choosing Wisely initiative:

  1. Avoid population-based screening for 25-hydroxy vitamin D deficiency.
  2. Refrain from low-risk human papillomavirus testing.
  3. Skip routine preoperative testing for low-risk surgeries without clinical indication.
  4. Reserve methylated Septin 9 for colon cancer screening when conventional diagnostics are not feasible.
  5. Do not use bleeding time tests to guide patient care.
  6. Do not order erythrocyte sedimentation rate for inflammation in undiagnosed conditions; use C-reactive protein instead.
  7. Do not test vitamin K levels without abnormal international normalized ratio and unresponsive to vitamin K therapy.
  8. Prescribe testosterone therapy only with laboratory evidence of deficiency.
  9. Do not test for myoglobin or creatine kinase-MB for acute myocardial infarction diagnosis; use troponin I or T.
  10. Avoid multiple tests for suspected non-neoplastic thyroid disease; start with thyroid-stimulating hormone and follow up accordingly.
  11. Skip sentinel lymph node biopsy for early, thin melanoma, as it does not improve survival.
  12. Do not routinely order expanded lipid panels for cardiovascular disease screening; standard lipid profile suffices.
  13. Test for lipase, not amylase, in suspected acute pancreatitis cases.
  14. Use stool antigen or breath test instead of serology for Helicobacter pylori.
  15. Do not perform fluorescence in situ hybridization for myelodysplastic syndrome on bone marrow samples if adequate karyotype is obtained.
  16. Avoid frozen section on pathology specimens if it won’t impact immediate patient management.
  17. Do not repeat hemoglobin electrophoresis if previous result doesn’t require intervention or monitoring.
  18. Skip testing for protein C, protein S, or antithrombin levels during active clotting events.
  19. Avoid red blood cell folate testing; consider supplementation for macrocytic anemia.
  20. Do not use sputum cytology for peripheral lung lesions evaluation; consider alternative diagnostic methods like image-guided needle aspiration.

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