NSCLC testing

[ygdrasil]

Our oncologists are asking for a lot of EGFR/ALK/ROS1 testing on lung adenocarcinomas. We've been sending out for sequencing and FISH, but we're running into a lot of quantity not sufficient problems on small biopsies and cell blocks.
I'm thinking of trying to bring in the ventana alk (d5f3) cdx immunostain with the idea that we'd at least get that result on most cases and that it might preserve some tissue to increase the success chance of the other two tests. Does anyone have experience or even an inexperienced opinion on this?

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[cmz]

You haven't been hit up with PD-L1 yet?

 

[ygdrasil]

No PD-L1, no (and, not having actually seen it, sounds like another semi-quantitative nightmare). And I should specify that the oncologists are requesting testing (not resting/ keeping abreast in/ shaving some zest in) high-stage tumors, not all adenos.

 

[gbwillner]

Send your material for lung adenos for molecular testing that does sequencing plus ROS1/ALK/RET.

QNS is likely due to serially sending for ancillary testing, or improper sampling. Sending out for a single test will significantly improve this.

Pm me if you need to.

 

[2121115]

PDL1 testing is being driven more by labs than oncologists at this point.

 

[Alteran]

My oncology colleagues don't give a hoot about PDL1 testing in the clinical setting. They've got some clinical trials going, but otherwise we're not hassled with that nonsense.

As for QNS testing, it's mostly a problem with the EBUS specimens in our experience. We go on the FNA for adequacy checks and I flat out say this likely isn't enough for molecular testing. Invariably the IR guys will be asked to needle it and it's usually enough. I ask for 6 good 1 cm cores unless I see a lot of necrosis on the adequacy TP. I have the tech then gross each core into its own cassette so we can separate it out better and not lose limited specimen each time the block gets used/faced for additional testing. This works out pretty well for us whether it's simple PCR testing, Foundation One, Paradigm, etc.

 

[ygdrasil]

ALK immunostain for NSCLC seems like a no-go for us. Ventana would really like us to use it on their stainer, which we don't have room to add. We could also do PDL1 testing on said stainer, but at the moment our oncologists are just adding an anti-PDL1 agent when patients progress through standard therapy. I'll suggest your each-core-in-its-own-cassette strategy to the lab, Alteran, thanks!

 

[stickyshift]

We get needle biopsies and have our techs cut 8 or 9 unstained slides up front. We use these slides for the ancillary studies.