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Molecular Diagnostics

CLSI MM19

Establishing Molecular Testing in Clinical Laboratory Environments

CLSI MM19 offers comprehensive guidance for the planning and implementation of molecular diagnostic testing. It covers strategic planning, regulatory requirements, implementation, quality management, and special considerations for the subspecialties of molecular genetics, infectious diseases, oncology, and pharmacogenetics.

This document is available exclusively in an electronic format for your convenience and accessibility.

November 30, 2011
Leslie Hall, MMSc, M(ASCP) and Jean Amos Wilson, PhD, FACMG, CGMB

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Abstract

Clinical and Laboratory Standards Institute document MM19-A—Establishing Molecular Testing in Clinical Laboratory Environments; Approved Guideline provides a framework for decision making and implementation of clinical molecular diagnostics, and is intended for those in established clinical laboratories that are implementing a molecular program for the first time. When implementing any diagnostic test for patient care, many elements should be addressed before the test is brought “online.” This document focuses on the path of workflow, including laboratory safety and the quality management system, with emphasis on considerations for molecular diagnostics. An organized approach to strategic planning with SWOT (strengths, weaknesses, opportunities, and threats) is presented. Relevant regulatory requirements and the implementation plan are discussed in detail. Importantly, separate sections are devoted to each of the following subspecialty areas: heritable diseases, oncology and malignant hematology, pharmacogenomics, and infectious diseases. Each of these sections addresses special considerations for molecular testing for each subspecialty.

Scope
This document was written by experienced molecular laboratory professionals to provide an introduction to molecular diagnostics for nonmolecular, routine clinical laboratories, as well as a framework for decision making and implementation of molecular testing. The target audience of this guideline is the stakeholders who play a role in the strategic decision to implement a molecular diagnostic program, including the: • Medical and technical directors who may not have previous experience with molecular testing • Supervisory technical staff who implement molecular assays for the first time • Quality management systems (QMS) group who will adapt the quality plan to incorporate the unique aspects of the new program • Production staff that will perform and maintain all aspects of the assays Because molecular diagnostics encompasses a very broad area, this document focuses on clinical applications and technologies most likely to be used in a laboratory that is venturing into molecular testing for the first time. The laboratory may have a concentration in a specific subspecialty (eg, microbiology) or not. However, given that this document is written for nonmolecular experts, several more complex areas of molecular testing were excluded from the scope, including: • Complex technologies, including, but not limited to, laboratory-developed tests (LDTs) that require primer and/or probe design, proteomics, pulsed-field gel electrophoresis, multiple locus sequence testing, and repetitive extragenic palindromic sequence-based polymerase chain reaction (PCR) • Complex reflex testing algorithms • Laboratory tests that require a high degree of clinical expertise to interpret, such as donor-recipient compatibility typing, and molecular typing of strains possibly related in an outbreak • Tests for sexual abuse and forensics • Tests of the blood and tissue supply (eg, blood banks) It is also out of the scope of this guideline to consider assays that should remain in specialized or esoteric testing facilities, such as: • Methods for detecting pathogens such as bioterrorism agents that require biosafety levels (BSL) 3 or greater, which are otherwise handled in specialized facilities • Prenatal diagnosis and preimplantation genetic diagnosis (PGD) of heritable disease
Product Details
MM19AE
1-56238-774-X
252
Additional Details

This document is available in electronic format only.

This archived document is no longer being reviewed through the CLSI Consensus Document Development Process. However, this document is technically valid and because of its value to the laboratory community, it is being retained in CLSI’s library.

Authors
Leslie Hall, MMSc, M(ASCP)
Jerry Boonyaratanakornkit, MS
Jean Amos Wilson, PhD, FACMG, CGMB
Bonita Bryant, MT(ASCP), CLSpMB(NCA)
Kathy Bernard, MSc, ARM(CCM)
Jianli Dong, MD, PhD, FACMG
Michele P. Carbone, MS, CLS(ASCP) SH
Rajyasree Emmadi, MD, FCAP
Haja Sittana El Mubarak, PhD
Manohar R. Furtado, PhD
Stephanie E. Hallam, PhD, FACMG, MBA
Felicitas Lacbawan, MD, FCAP, FACMG
Roger D. Klein, MD, JD, FCAP
Francisco Martinez-Murillo, PhD
Preeti Pancholi, PhD, D(ABMM)
Ted E. Schutzbank, PhD, D(ABMM)
Michele M. Schoonmaker, PhD
Rangaraj Selvarangan, BVSc, PhD, D(ABMM)
Elaine B. Spector, PhD, FACMG
Venkatakrishna Shyamala, PhD
Patrik Vitazka, MD, PhD
Laurina O. Williams, PhD, MPH
Alan Wu, PhD, DABCC
Abstract

Clinical and Laboratory Standards Institute document MM19-A—Establishing Molecular Testing in Clinical Laboratory Environments; Approved Guideline provides a framework for decision making and implementation of clinical molecular diagnostics, and is intended for those in established clinical laboratories that are implementing a molecular program for the first time. When implementing any diagnostic test for patient care, many elements should be addressed before the test is brought “online.” This document focuses on the path of workflow, including laboratory safety and the quality management system, with emphasis on considerations for molecular diagnostics. An organized approach to strategic planning with SWOT (strengths, weaknesses, opportunities, and threats) is presented. Relevant regulatory requirements and the implementation plan are discussed in detail. Importantly, separate sections are devoted to each of the following subspecialty areas: heritable diseases, oncology and malignant hematology, pharmacogenomics, and infectious diseases. Each of these sections addresses special considerations for molecular testing for each subspecialty.

Scope
This document was written by experienced molecular laboratory professionals to provide an introduction to molecular diagnostics for nonmolecular, routine clinical laboratories, as well as a framework for decision making and implementation of molecular testing. The target audience of this guideline is the stakeholders who play a role in the strategic decision to implement a molecular diagnostic program, including the: • Medical and technical directors who may not have previous experience with molecular testing • Supervisory technical staff who implement molecular assays for the first time • Quality management systems (QMS) group who will adapt the quality plan to incorporate the unique aspects of the new program • Production staff that will perform and maintain all aspects of the assays Because molecular diagnostics encompasses a very broad area, this document focuses on clinical applications and technologies most likely to be used in a laboratory that is venturing into molecular testing for the first time. The laboratory may have a concentration in a specific subspecialty (eg, microbiology) or not. However, given that this document is written for nonmolecular experts, several more complex areas of molecular testing were excluded from the scope, including: • Complex technologies, including, but not limited to, laboratory-developed tests (LDTs) that require primer and/or probe design, proteomics, pulsed-field gel electrophoresis, multiple locus sequence testing, and repetitive extragenic palindromic sequence-based polymerase chain reaction (PCR) • Complex reflex testing algorithms • Laboratory tests that require a high degree of clinical expertise to interpret, such as donor-recipient compatibility typing, and molecular typing of strains possibly related in an outbreak • Tests for sexual abuse and forensics • Tests of the blood and tissue supply (eg, blood banks) It is also out of the scope of this guideline to consider assays that should remain in specialized or esoteric testing facilities, such as: • Methods for detecting pathogens such as bioterrorism agents that require biosafety levels (BSL) 3 or greater, which are otherwise handled in specialized facilities • Prenatal diagnosis and preimplantation genetic diagnosis (PGD) of heritable disease
Additional Details

This document is available in electronic format only.

This archived document is no longer being reviewed through the CLSI Consensus Document Development Process. However, this document is technically valid and because of its value to the laboratory community, it is being retained in CLSI’s library.

Authors
Leslie Hall, MMSc, M(ASCP)
Jerry Boonyaratanakornkit, MS
Jean Amos Wilson, PhD, FACMG, CGMB
Bonita Bryant, MT(ASCP), CLSpMB(NCA)
Kathy Bernard, MSc, ARM(CCM)
Jianli Dong, MD, PhD, FACMG
Michele P. Carbone, MS, CLS(ASCP) SH
Rajyasree Emmadi, MD, FCAP
Haja Sittana El Mubarak, PhD
Manohar R. Furtado, PhD
Stephanie E. Hallam, PhD, FACMG, MBA
Felicitas Lacbawan, MD, FCAP, FACMG
Roger D. Klein, MD, JD, FCAP
Francisco Martinez-Murillo, PhD
Preeti Pancholi, PhD, D(ABMM)
Ted E. Schutzbank, PhD, D(ABMM)
Michele M. Schoonmaker, PhD
Rangaraj Selvarangan, BVSc, PhD, D(ABMM)
Elaine B. Spector, PhD, FACMG
Venkatakrishna Shyamala, PhD
Patrik Vitazka, MD, PhD
Laurina O. Williams, PhD, MPH
Alan Wu, PhD, DABCC