The standards for reporting diagnostic accuracy studies 2015 update: is there a missing link to the triumvirate?

The troika of pre-analytical, analytical and post-analytical testing phases in laboratory medicine is well known to all first year clinical laboratorians as the phases of lab testing that must be controlled in order to produce accurate, valid laboratory results for diagnostic purposes. The need to control these three testing phases is distinct for the evaluation of diagnostic accuracy of laboratory medical tests and its reporting compared to other medical specialties that utilize diagnostic testing. In fact, evidence has established that up to 70% of laboratory errors and failures occur in the pre-analytical phase (1-3), with the post-analytical testing phase is the second most error prone testing phase; by comparison, the analytical phase is relatively low.