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      Structure and content of the EU-IVDR : Current status and implications for pathology Translated title: Struktur und Inhalt der EU-IVDR : Bestandsaufnahme und Implikationen für die Pathologie

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          Abstract

          Background

          Regulation (EU) 2017/746 on in vitro diagnostic medical devices (IVDR) was passed by the European Parliament and the Council of the European Union on 5 April 2017 and came into force on 26 May 2017. A new amending regulation, which introduces a phased implementation of the IVDR with new transitional provisions for certain in vitro diagnostic medical devices (IVDs) and a later date of application of some requirements for in-house devices for healthcare facilities, was adopted on 15 December 2021.

          The combined use of CE-certified IVDs (CE-IVDs), in-house IVDs (IH-IVDs), and research use only (RUO) devices are a cornerstone of diagnostics in pathology departments and crucial for optimal patient care. The IVDR not only regulates the manufacture and placement on the market of industrially manufactured IVDs, but also imposes conditions on the manufacture and use of IH-IVDs for internal use by healthcare facilities.

          Objectives

          Our work provides an overview of the background and structure of the IVDR and identifies core areas that need to be interpreted and fleshed out in the context of the legal framework as well as expert knowledge.

          Conclusions

          The gaps and ambiguities in the IVDR crucially require the expertise of professional societies, alliances, and individual stakeholders to successfully facilitate the implementation and use of the IVDR in pathology departments and to avoid aberrant developments.

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          Most cited references12

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          Guidelines for Validation of Next-Generation Sequencing-Based Oncology Panels: A Joint Consensus Recommendation of the Association for Molecular Pathology and College of American Pathologists.

          Next-generation sequencing (NGS) methods for cancer testing have been rapidly adopted by clinical laboratories. To establish analytical validation best practice guidelines for NGS gene panel testing of somatic variants, a working group was convened by the Association of Molecular Pathology with liaison representation from the College of American Pathologists. These joint consensus recommendations address NGS test development, optimization, and validation, including recommendations on panel content selection and rationale for optimization and familiarization phase conducted before test validation; utilization of reference cell lines and reference materials for evaluation of assay performance; determining of positive percentage agreement and positive predictive value for each variant type; and requirements for minimal depth of coverage and minimum number of samples that should be used to establish test performance characteristics. The recommendations emphasize the role of laboratory director in using an error-based approach that identifies potential sources of errors that may occur throughout the analytical process and addressing these potential errors through test design, method validation, or quality controls so that no harm comes to the patient. The recommendations contained herein are intended to assist clinical laboratories with the validation and ongoing monitoring of NGS testing for detection of somatic variants and to ensure high quality of sequencing results.
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            Comparative sensitivity evaluation for 122 CE-marked rapid diagnostic tests for SARS-CoV-2 antigen, Germany, September 2020 to April 2021

            Introduction Numerous CE-marked SARS-CoV-2 antigen rapid diagnostic tests (Ag RDT) are offered in Europe, several of them with unconfirmed quality claims. Aim We performed an independent head-to-head evaluation of the sensitivity of SARS-CoV-2 Ag RDT offered in Germany. Methods We addressed the sensitivity of 122 Ag RDT in direct comparison using a common evaluation panel comprised of 50 specimens. Minimum sensitivity of 75% for panel specimens with a PCR quantification cycle (Cq) ≤ 25 was used to identify Ag RDT eligible for reimbursement in the German healthcare system. Results The sensitivity of different SARS-CoV-2 Ag RDT varied over a wide range. The sensitivity limit of 75% for panel members with Cq ≤ 25 was met by 96 of the 122 tests evaluated; 26 tests exhibited lower sensitivity, few of which failed completely. Some RDT exhibited high sensitivity, e.g. 97.5 % for Cq < 30. Conclusions This comparative evaluation succeeded in distinguishing less sensitive from better performing Ag RDT. Most of the evaluated Ag RDT appeared to be suitable for fast identification of acute infections associated with high viral loads. Market access of SARS-CoV-2 Ag RDT should be based on minimal requirements for sensitivity and specificity.
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              Current practices and guidelines for clinical next-generation sequencing oncology testing

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                Author and article information

                Contributors
                andy.kahles@med.uni-heidelberg.de
                albrecht.stenzinger@med.uni-heidelberg.de
                Journal
                Pathologie (Heidelb)
                Pathologie (Heidelb)
                Pathologie (Heidelberg, Germany)
                Springer Medizin (Heidelberg )
                2731-7188
                2731-7196
                3 February 2023
                3 February 2023
                : 1-13
                Affiliations
                [1 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Institute of Pathology, , Heidelberg University Hospital, ; Heidelberg, Germany
                [2 ]Professional Association of German Pathologists, Bundesverband Deutscher Pathologen e. V., Berlin, Germany
                [3 ]GRID grid.412282.f, ISNI 0000 0001 1091 2917, Department of Pathology, , University Hospital Carl Gustav Carus, Technische Universität Dresden, ; Dresden, Germany
                [4 ]GRID grid.6936.a, ISNI 0000000123222966, Institute of Pathology, , Technical University of Munich, ; Munich, Germany
                [5 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Institute of Pathology, , Charité—Universitätsmedizin Berlin, ; Berlin, Germany
                [6 ]GRID grid.5252.0, ISNI 0000 0004 1936 973X, Institute of Pathology, , Ludwig-Maximilian University of Munich, ; Munich, Germany
                [7 ]GRID grid.7307.3, ISNI 0000 0001 2108 9006, Faculty of Law, , University of Augsburg, ; Augsburg, Germany
                [8 ]GRID grid.412468.d, ISNI 0000 0004 0646 2097, 2nd Internal Medicine Department, Hematology Lab Kiel, , University Hospital Schleswig-Holstein (UKSH), ; Kiel, Germany
                [9 ]GRID grid.5252.0, ISNI 0000 0004 1936 973X, Institute of Laboratory Medicine, , Ludwig-Maximilian University of Munich, ; Munich, Germany
                Article
                1176
                10.1007/s00292-022-01176-z
                9896441
                36735063
                d4c030e8-7f7b-4501-a9e4-16653012068a
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 20 December 2022
                Funding
                Funded by: Universitätsklinikum Heidelberg (8914)
                Categories
                Review Article

                diagnostic reagent kits,quality of healthcare,government regulation,in-house production,laboratory-developed tests

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