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Unintended consequences of Mayo paraneoplastic evaluations.

Authors
  • Ebright, Matthew J1
  • Li, Shih-Hon1
  • Reynolds, Evan1
  • Burke, James F1
  • Claytor, Ben R1
  • Grisold, Anna1
  • Banerjee, Mousumi1
  • Callaghan, Brian C2
  • 1 From the Health Services Research Program (M.J.E., J.F.B., B.R.C., B.C.C.), Department of Neurology, Department of Pathology (S.-H.L.), and Department of Biostatistics (E.R., M.B.), School of Public Health, University of Michigan; Veterans Affairs Healthcare System (J.F.B., B.C.C.), Ann Arbor, MI; and Department of Neurology (A.G.), Medical University of Vienna, Austria. , (Austria)
  • 2 From the Health Services Research Program (M.J.E., J.F.B., B.R.C., B.C.C.), Department of Neurology, Department of Pathology (S.-H.L.), and Department of Biostatistics (E.R., M.B.), School of Public Health, University of Michigan; Veterans Affairs Healthcare System (J.F.B., B.C.C.), Ann Arbor, MI; and Department of Neurology (A.G.), Medical University of Vienna, Austria. [email protected] , (Austria)
Type
Published Article
Journal
Neurology
Publisher
Ovid Technologies (Wolters Kluwer) - American Academy of Neurology
Publication Date
Nov 27, 2018
Volume
91
Issue
22
Identifiers
DOI: 10.1212/WNL.0000000000006577
PMID: 30366974
Source
Medline
Language
English
License
Unknown

Abstract

To determine the proportion of true and false positives from paraneoplastic panels and effects on downstream testing/treatment. Using a retrospective cohort study design, we identified 500 consecutive patients with Mayo paraneoplastic autoantibody testing and performed chart abstraction. Paraneoplastic presentation types were categorized into probable, possible, and other by consensus. True positives were defined as a positive antibody titer with no other explanation found in addition to one of the following: syndrome known to be associated with the antibody, clinical improvement with treatment, and new malignancy. Comparisons of diagnostic testing and treatments between false and true positives were performed. Multivariable logistic regression was used to evaluate associations between patient-level factors and true positives. The mean (SD) age of the population was 55.4 (17.1) years, and 55.4% were female, with 1.3 (1.2) years of follow-up. Of the 500 tests, 87 (17.4%, 95% confidence interval [CI] 14.1%-20.7%) were positive and 62 (71.3%, 95% CI 61.8%-80.8%) of these were false positives. Of those with a possible/other presentation (n = 369), 2 (0.5%, 95% CI 0.0%-1.0%) were true positives. CT of the chest (30.7% vs 11.8%, p ≤ 0.01) was performed more often in false positives than true negatives. Probable presentation type (odds ratio [OR] 57.9, 95% CI 12.5-268.0) and outpatient setting (OR 8.7, 95% CI 2.4-31.8) were associated with true-positive results. Paraneoplastic tests result in a large proportion of false positives, particularly in those with clinical presentations that are not well established as paraneoplastic diseases. Future work should construct panels targeted to specific clinical presentations and ensure that tests are ordered in the appropriate clinical context. © 2018 American Academy of Neurology.

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