Overview
Discordant molecular results are conflicts between a molecular call and another laboratory method, a prior molecular result, or expected clinical findings, evaluated after specimen acceptability and controls are confirmed.
Classification
| Workup step | Focus |
|---|---|
| Identity & specimen | Correct patient, type, order |
| Controls & validity | Assay acceptance criteria |
| Method comparison | Targets, sensitivity, timing, matrix |
| Lab failure modes | Contamination, inhibition, mislabel, LIS error |
| Escalate & report | SOP comments / supervisor / clinical contact |
Morphologic Features
Not applicable, this entry covers molecular interpretation workflow, not morphologic identification.
Laboratory Characteristics
- Hold only when analytical validity is uncertain
- Quantitative comparisons need matching units and reportable ranges
- Inconclusive language follows the assay procedure
Reference Intervals
Not a universal numeric interval. Cross-method comparison requires assay-specific cutoffs, units, and reportable ranges. Ct/Cq values are method-dependent.
Clinical and Laboratory Significance
Discordance often reflects method differences rather than a single 'wrong' answer. Molecular detection does not prove active disease alone; not-detected does not exclude disease alone.
Differential Considerations
Consider wrong specimen, contamination, inhibition, timing/site differences, colonization vs disease context, and true method discordance before forcing agreement.
Comparison Tables
Discordance checkpoints
| Statement | Safe understanding | Unsafe shortcut |
|---|---|---|
| Molecular + / antigen − | Different methods; verify then explain | Change molecular to negative |
| Patient looks well | Correlate; escalate if needed | Silently alter valid result |
| Ct lower than yesterday | Method-dependent readout | Disease worsening proven |
Classification Frameworks
Not applicable . World Health Organization (WHO) disease classifications do not define molecular discordance workflow.
Laboratory Notes
- Validity first, then method/specimen/timing comparison
- Never silently rewrite valid molecular results
- Positive ≠ active disease; negative ≠ exclude; invalid ≠ negative
References
Authoritative textbooks, guidelines, and reviews supporting this reference entry. Verify reference intervals, critical limits, and reflex criteria against institutional protocols and current guideline editions.
Textbooks
- McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Elsevier; 2021. (Molecular diagnostics chapters, verify current edition.)
- Buckingham L. Molecular Diagnostics: Fundamentals, Methods, and Clinical Applications. 3rd ed. F.A. Davis; 2019. (Verify current edition.)
CLSI and Professional Guidelines
- Clinical and Laboratory Standards Institute (CLSI). Consult current CLSI molecular method documents available through your laboratory, document numbers and editions change; do not treat any single CLSI title as universal.
- Institutional molecular laboratory SOPs, assay manufacturer instructions for use (IFU), and locally adopted accreditation requirements. Always verify current local practice.
Frequently Asked Questions
Common questions about using this Discordant Results additional test references Medical Laboratory Library reference in Medical Laboratory Science education.
What is the Discordant Results laboratory reference?
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Can reference details vary between laboratories?
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