To evaluate the frequency and cost associated with unindicated laboratory tests on paracentesis and thoracentesis specimens from patients with gynecologic cancers and highlight potential areas for waste minimization.
Approach:
Study Design: Retrospective review of consecutive patients diagnosed with gynecologic cancer who underwent paracentesis or thoracentesis from 2015 to 2025 at a single tertiary-care institution.
Patient Exclusion Criteria: Patients with a second cancer or medical comorbidities contributing to ascites or pleural effusions were excluded.
Data Analysis: Clinical scenarios were evaluated to determine the indication for laboratory tests. Costs were obtained from institutional financial records, and statistical analysis was performed using Fisher exact tests and logistic regression.
Key Findings:
216 patients with gynecologic cancers were included; median age at diagnosis was 62.9 years.
78% of patients underwent at least one paracentesis, and 45% underwent at least one thoracentesis.
40% of procedures had laboratory test results sent; 79% of these had at least one unindicated test.
Total cost from unindicated laboratory tests was $1,129,520.
The most common unindicated laboratory tests included fluid culture (77%), cell count (73%), fluid protein (73%), and cytology (66%).
Non-oncology clinicians had higher odds of ordering unindicated tests compared to oncology clinicians.
Interpretation:
Routine fluid laboratory tests should not be reflexively ordered in patients with established cancer diagnoses unless relevant clinical symptoms are present.
Limitations:
Findings may not be generalizable due to the single-institution and retrospective nature of the study.
Diversity of medical systems may affect the applicability of results.
Conclusion:
Future interventions should explore optimizing order sets and clinician education to reduce unnecessary laboratory testing.
