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Screening and confirmation testing are performed using different methodologies that necessitate different cutoff levels. The cutoff levels of an immunoassay screen are typically higher than those of a more sensitive GC-MS or LC-MS/MS confirm test, because they screen for a larger group of parent compounds, metabolites and other structurally similar compounds.
If an immunoassay test detects a drug (above the screening cutoff level) the presumptive positive specimen may be sent to GC-MS or LC-MS/MS confirmation testing. Many times, these individual compounds are present in concentrations much lower than the total immunoassay response, thus resulting for the cutoff levels being lower for the GC-MS or LC-MS/MS test.
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