2 The role of cellular pathology departments in the improvement of turnaround times for lung adenocarcinoma biomarker testing

Abstract

Introduction Genomic profiling of non-small cell lung cancer was centralised in April 2021 to 7 Genomic Laboratory Hubs (GLHs) to improve turnaround times (TATs) and access to standardised genomic testing for predictive biomarkers. However, challenges remain in delivering a service meeting the NHSE 10-day molecular testing standard1,2. We report a 2-year service evaluation and improvement project at Barts Health NHS Trust (BHT; North Thames GMSA) partnered with Amgen UK & Ireland, which has delivered significant improvements in the key performance indicators (KPIs) of TATs, DNA quality and test inadequate rates. Methods The study involved the following: 1. Retrospective audit of lung adenocarcinoma (LUAD) pathology pathway from date of tissue acquisition to a clinically relevant report. 2. Process mapping of the pathology pathway. 3. Identification of barriers to faster TATs and implementation of service improvements. 4. Prospective audit of LUAD pathology pathway to identify improvements in KPIs. Results 60 LUAD specimens were audited between Apr-Jun 2022 and 39 LUAD in Sep-Oct 2023. Service expansion in cut-up facilities, laboratory technicians, staff training and streamlining of the pathology pathway resulted in an improvement (DELTA) in almost all parameters including: reduced TAT of diagnostic reporting of biopsies (mean TAT-B: DELTA3.2 days) and resections (mean TAT-R: DELTA12.3 days); molecular reporting (meanTAT-B: DELTA2.2 days; mean TAT-R: DELTA12.3 days); decreased NGS failure rates (3.3% to 0%); improved TAT for PD-L1 immunohistochemistry (3-dayTAT-B: DELTA 58%; 3-dayTAT-R: DELTA11.6%) and ALK/ROS1 immunohistochemistry (3-dayTAT-B: DELTA12%; 3-dayTAT-R: DELTA26%) tumour content assessment (71.6% to 98.4%) and reduced overall TAT from tissue acquisition to molecular report (mean TAT-B: 35 to 31 days; mean TAT-R: 56 to 33 days). Conclusions Our study has service improvement recommendations that may be transferrable to other networks in the UK. Re-evaluation of National Optimal Lung Cancer Pathway (NOLCP) guidelines and implementation of Cellular Pathology Genomics Centres (CPGCs) is recommended. Disclosure No significant relationships.