In October 2017, the American Society for Clinical Pathology (ASCP) outlined 20 “do nots” as part of the Choosing Wisely initiative:
- Avoid population-based screening for 25-hydroxy vitamin D deficiency.
- Refrain from low-risk human papillomavirus testing.
- Skip routine preoperative testing for low-risk surgeries without clinical indication.
- Reserve methylated Septin 9 for colon cancer screening when conventional diagnostics are not feasible.
- Do not use bleeding time tests to guide patient care.
- Do not order erythrocyte sedimentation rate for inflammation in undiagnosed conditions; use C-reactive protein instead.
- Do not test vitamin K levels without abnormal international normalized ratio and unresponsive to vitamin K therapy.
- Prescribe testosterone therapy only with laboratory evidence of deficiency.
- Do not test for myoglobin or creatine kinase-MB for acute myocardial infarction diagnosis; use troponin I or T.
- Avoid multiple tests for suspected non-neoplastic thyroid disease; start with thyroid-stimulating hormone and follow up accordingly.
- Skip sentinel lymph node biopsy for early, thin melanoma, as it does not improve survival.
- Do not routinely order expanded lipid panels for cardiovascular disease screening; standard lipid profile suffices.
- Test for lipase, not amylase, in suspected acute pancreatitis cases.
- Use stool antigen or breath test instead of serology for Helicobacter pylori.
- Do not perform fluorescence in situ hybridization for myelodysplastic syndrome on bone marrow samples if adequate karyotype is obtained.
- Avoid frozen section on pathology specimens if it won’t impact immediate patient management.
- Do not repeat hemoglobin electrophoresis if previous result doesn’t require intervention or monitoring.
- Skip testing for protein C, protein S, or antithrombin levels during active clotting events.
- Avoid red blood cell folate testing; consider supplementation for macrocytic anemia.
- Do not use sputum cytology for peripheral lung lesions evaluation; consider alternative diagnostic methods like image-guided needle aspiration.
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