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Microsatellite instability testing algorithm. Either immunohistochemistry or microsatellite instability (MSI) polymerase chain reaction based assessment are acceptable, however immunohistochemistry is more cost effective. Each test will miss about 5–15% of Lynch syndrome cases and an alternate test should be considered in cases with a high pretest probability if results are negative. Consider a genetics referral for any high-risk family history with negative testing.
