Abstract
Molecular biomarker testing is essential to the work up of metastatic and advanced non-small cell lung carcinoma. Despite molecular testing guidelines proposed by the National Comprehensive Cancer Network, Association for Molecular Pathology, and many others, multiple reports continue to indicate that lung cancer patients are inadequately tested for key molecular biomarkers. Within our hospital system, reflex ordered testing of a panel of molecular biomarkers in all newly diagnosed lung adenocarcinomas was approved and implemented in 2017. Reflex ordered testing demonstrated significant improvements in both turnaround times for reporting of molecular results and frequency of variant detection in these patients. Over time, this reflex ordered testing strategy for molecular biomarkers in lung adenocarcinoma has been maintained and expanded to include additional biomarkers such as NTRK1 and NTRK3 gene rearrangements.
In the current study, we re-assessed the impact of reflex ordered molecular biomarker testing for lung adenocarcinoma in our hospital system two years following its implementation. We evaluated the turnaround times for reporting of reflex ordered molecular biomarker testing, as well as the frequency of variant detection among a cohort of newly diagnosed lung adenocarcinoma specimens sent to our laboratory for molecular testing between September and December 2019. The average turnaround time for reporting of reflex ordered molecular biomarker results in 2019 was comparable to our previous findings, as was the frequency of variant detection. In the current study, the turnaround time for reporting of results for send-out testing of a reflex ordered molecular biomarker took 6 days longer, on average, than the reporting of results for molecular testing performed in-house. Overall, a reflex ordered testing strategy improves turnaround times, improves frequency of variant detection, and standardizes the molecular biomarker work up for lung adenocarcinoma, which may lead to decreased time to initiation of optimal therapy and improved patient outcomes.
Keywords
Non-small cell lung carcinoma, Reflex molecular biomarker testing