Hemoccult Testing on Nipple Discharge

Sounds like you've got a rogue physician there.  That's off-label testing for sure - so if you continue to allow it, you'd be up against high-complexity testing guidelines unless you validate that specimen type.

I haven't seen it but we've had posts on other listserves asking about that. MDs are not the only 'think they have a good idea' folks in ambulatories/clinics so try to find out who spearheaded this activity. Quite a few PAs, Nurse Clinicians, NPs and RN with or without BS degrees don't mind 'being creative' (in their minds). Since it's off-label, as James says, I wouldn't hesitate to go to the CLIA Director and make a case for immediately stopping the activity. If it's an MD on the CLIA Certificate then it's up to them to get the support from the lab to validate the specimen type.

What I thought. Thank you! We only allow waived testing and they have hard enough time to follow those slim regulations.

After I banged my head and the desk I told them to stop any testing until I get back to them.

Anastasia

Anastasia,

We have been round and round with this one. It seems to resurface about every 2 years or so. I agree with all the sentiments above. And wanted to add that when you google the topic you are up against some very "powerful and compelling" arguments from Oncologists who support this use of the Hemoccult test. They have many published articles "validating" their use in the office setting for check up on breast cancer patients.

However, I reached out to the Beckman Coulter rep two years ago and he said that he gets this question about 3 times a year. His scientific team all agree that it is not good practice and they don't support this off label use of their product. 

I wish you luck on this battle. We focused on helping our providers collect a specimen to be sent to the lab for testing and a timely fashion rather than converting to any high complexity testing. 

Jeanne 

I'm curious Jeanne - once in the lab, THEN what do you do with it? 

James, 

I went back through old email chains and the only evidence I found was from Hershey Medical where they perform testing in their cytology department. What specific tests, I do not know.

here are some tidbits from that message:

Specimen Preparation (In House):
Gently express secretion from nipple and quickly spread on a glass slide (pre-labeled with patient's name and hospital ID number). This can be done by touching the glass slide to the surface of the nipple, or by transferring the drop of secretion from the nipple to the slide on a nonabsorbent cotton swab which has been pre-moistened with physiologic saline. Rapidly fix with a spray fixative (hold can 10-112 inches from the side) to prevent drying artifact. Make as many smears as the secretion allows, but prepare each slide individually and spray fixing each slide as it is prepared. Allow slides to dry and place in suitable cardboard or other carriers for transport to the lab.

I then tried to look up this testing on our own test directory only to learn that it is under construction. I am really sorry to say that I don't have an answer at this time. I can reach out to our cyto folks, but that will take me some time. I will try to update this with an answer. 

Jeanne

Oh, don't bother Jeanne, that's quite alright - I was mostly just curious what was being substituted.  Sounds like that's heading the direction of doing some sort of a heme stain, I would guess.  Wonder how that would compare to the hemoccult testing.  Of course, the REAL question is does it give the docs the answer they WANT rather than the true result, lol...

The test, I believe, is called a Tzanck smear.

yes, sounds right...