Table 2 Recommendations around key aspects of analysis and reporting
Category | Key recommendations | Additional considerations |
|---|---|---|
Diagnostic report | • Clearly state the final diagnosis and need for additional IHC • Clearly state the best block for molecular studies, and the percentage of tumor in that block, with a rough estimation of tumor volume if scant • Comment on sample quality and suitability • Follow local guidelines to indicate what tests are recommended and if referral is necessary • Testing for biomarkers mandatory for initial treatment of NSCLC must be completed within 10 working days | Results should be ideally discussed in MDT board meeting |
Types of tests | • When multiple genes are going to be tested, NGS is more cost-effective • PD-L1 detection should be performed by IHC • Single-gene testing can be performed by RT-PCR • ALK IHC can be performed o assess ALK fusion status • NTRK and ROS1 IHC can be used as screening, but need confirmatory by additional methods • For RET fusions, IHC is not recommended | In advances NSCLC, combined RNA/DNA NGS with PD-L1 immunohistochemistry is probably the ideal scenario, if available and the cost is covered |