American Society for Clinical Pathology

View all recommendations from this society

October 19, 2017

Do not use sputum cytology to evaluate patients with peripheral lung lesions.

Sputum cytology is not effective for evaluating peripheral lesions. For peripheral lesion evaluation, consider alternative diagnostic approaches (e.g., image guided needle aspiration).


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

1-5: The American Society for Clinical Pathology (ASCP) list was developed under the leadership of the chair of ASCP’s Institute Advisory Committee and Past President of ASCP. Subject matter and test utilization experts across the fields of pathology and laboratory medicine were included in this process for their expertise and guidance. The review panel examined hundreds of options based on both the practice of pathology and evidence available through an extensive review of the literature. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and, eliminating it or changing to another test is within the control of the clinician. The final list is not exhaustive (many other tests/procedures were also identified and were also worthy of consideration), but the recommendations, if instituted, would result in higher quality care, lower costs, and more effective use of our laboratory resources and personnel.

6–10: The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Choosing Wisely Ad Hoc Committee. This committee is chaired by an ASCP Past President and is comprised of subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered an initial list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees and councils. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs and a more effective use of our laboratory resources and personnel.

11–15: The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Effective Test Utilization Subcommittee. This committee is chaired by an ASCP Past President and comprises subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered an initial list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees, and councils. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful (either entirely or in specific clinical situations); use of the test is costly and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs, and a more effective use of our laboratory resources and personnel.

16–20: The American Society for Clinical Pathology (ASCP) list of recommendations was developed under the leadership of the ASCP Effective Test Utilization Steering Committee. This committee is chaired by an ASCP Past President and comprises of subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered a list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees and councils. In addition, an announcement was made to ASCP’s membership seeking suggestions for possible recommendations to promote member involvement. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician. Implemetation of these recommendations will result in higher quality care,lower costs and a more effective use of our laboratory resources and personnel.

ASCP’s disclosure and conflict of interest policy can be found at www.ascp.org.

Sources

Demay RM, The Art & Science of Cytopathology. Chicago, IL: ASCP Press; 1996

Felten MK, Knoll L, Schikowsky C, et al. Is it useful to combine sputum cytology and low-dose spiral computed tomography for early detection of lung cancer in formerly asbestos-exposed power industry workers? J Occup Med Tox. 2014; 9(14): 1-9.

Katz RL, Zaidi TM, Fernandez RL, et al. Automated detection of genetic abnormalities combined with cytology in sputum is a sensitive predictor of lung cancer. Mod Pathol. 2008; 21(8): 950-960.

Read C, Janes S, George J, Spiro S. Early lung cancer: Screening and detection. Prim Care Respir J. 2006; 15(6): 332-336.

Xiang D, Zhang B, Doll D, Shen K, Kloecker G, Freter C. Lung cancer screening: From imaging to biomarker. Biomarker Res. 2013; 1(4): 1-9.

Usman AM, Miller J, Peirson L, Fitzpatrick-Lewis D, Kenny M, Sherifali D, Raina P. Screening for lung cancer: a systematic review and meta-analysis. Prev Med [Internet] 2016 Aug. [Cited 2017 July 14]; 89:301-14.