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Brier et al. make a great point that even great tests fail when performed in low-prevalence populations. This is the biggest problem with current paraneoplastic testing as indication creep has occurred with neurologists sending this test in very low clinical scenarios. Fixing this issue should be a high priority to improve current practice. However, the current panel also includes several antibodies in 1 panel, including those that are for central and those that are for peripheral conditions. The lumping of tests that should rarely—if ever—all be performed on the same patient increases the likelihood of false-positive results. In addition to optimizing the patient population who receive these tests, we also need to create optimal bundles of antibodies that are more specific to the clinical presentation.
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- © 2019 American Academy of Neurology
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