Lab Med Online.  2012 Jan;2(1):1-9. 10.3343/lmo.2012.2.1.1.

Translation: Roadmap for Harmonization of Clinical Laboratory Measurement Procedures

• Miller WG
• Myers GL
• Gantzer ML
• Kahn SE
• Schonbrunner ER
• Thienpont
• Bunk DM
• Christenson RH
• Eckfeldt J
• Lo SF
• Nubling CM
• Sturgeon C

• KMID: 1435745
• DOI: http://doi.org/10.3343/lmo.2012.2.1.1

Abstract

Results between different clinical laboratory measurement procedures (CLMP) should be equivalent, within clinically meaningful limits, to enable optimal use of clinical guidelines for disease diagnosis and patient management. When laboratory test results are neither standardized nor harmonized, a different numeric result may be obtained for the same clinical sample. Unfortunately, some guidelines are based on test results from a specific laboratory measurement procedure without consideration of the possibility or likelihood of differences between various procedures. When this happens, aggregation of data from different clinical research investigations and development of appropriate clinical practice guidelines will be flawed. A lack of recognition that results are neither standardized nor harmonized may lead to erroneous clinical, financial, regulatory, or technical decisions. Standardization of CLMPs has been accomplished for several measurands for which primary (pure substance) reference materials exist and/or reference measurement procedures (RMPs) have been developed. However, the harmonization of clinical laboratory procedures for measurands that do not have RMPs has been problematic owing to inadequate definition of the measurand, inadequate analytical specificity for the measurand, inadequate attention to the commutability of reference materials, and lack of a systematic approach for harmonization. To address these problems, an infrastructure must be developed to enable a systematic approach for identification and prioritization of measurands to be harmonized on the basis of clinical importance and technical feasibility, and for management of the technical implementation of a harmonization process for a specific measurand.

MeSH Terms

Humans
Sensitivity and Specificity

Figure

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  Fig. 1 Concept of commutability of results for reference materials with results for a panel of individual clinical samples. (A) results for commutable reference materials that have the same numeric relationship between 2 measurement procedures as observed for a panel of patient samples. (B) results for noncommutable reference materials that have a different numeric relationship between 2 measurement procedures than observed for the patient samples.

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  Fig. 2 Proposed schema for developing method harmonization criteria based on Kenny et al. (31). TEa derived from allowable bias and imprecision, for the agreement of results among different measurement procedures.

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  Fig. 3 General process for assessing and achieving harmonization (equivalency) of clinical laboratory measurement results.

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  Fig. 4 Overview of a general approach to manage harmonization of a measurand.

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