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Taniere P, Nicholson AG, Gosney JR, Montero Fernandez MA, Bury D, Moore DA, Verghese E, Soomro I, Joseph L, Bhatt N, Viola P, Bains R, Lanctot AG, Ryan J. Landscape of cancer biomarker testing in England following genomic services reconfiguration: insights from a nationwide pathologist survey. J Clin Pathol 2024; 77:486-494. [PMID: 37258251 PMCID: PMC11228219 DOI: 10.1136/jcp-2023-208890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/29/2023] [Indexed: 06/02/2023]
Abstract
AIMS Cancer diagnostics have been evolving rapidly. In England, the new National Health Service Genomic Medicine Service (GMS) provides centralised access to genomic testing via seven regional Genomic Laboratory Hubs. The PATHways survey aimed to capture pathologists' experience with current diagnostic pathways and opportunities for optimisation to ensure equitable and timely access to biomarker testing. METHODS A nationwide survey was conducted with consultant pathologists from regional laboratories, via direct interviews based on a structured questionnaire. Descriptive analysis of responses was undertaken using quantitative and qualitative methods. RESULTS Fifteen regional centres completed the survey covering a median population size of 2.5 (1.9-3.6) million (each for n=12). The median estimated turnaround time (calendar days) for standard molecular markers in melanoma, breast and lung cancers ranged from 2 to 3 days by immunohistochemistry (excluding NTRKfus in breast and lung cancers, and PD-L1 in melanoma) and 6-15 days by real-time-PCR (excluding KIT for melanoma), to 17.5-24.5 days by next-generation sequencing (excluding PIK3CA for breast cancer). Tests were mainly initiated by pathologists and oncologists. All respondents discussed the results at multidisciplinary team (MDT) meetings. The GMS roll-out was perceived to have high impact on services by 53% of respondents, citing logistical and technical issues. Enhanced education on new pathways, tissue requirements, report interpretation, providing patient information and best practice sharing was suggested for pathologists and other MDT members. CONCLUSION Our survey highlighted the role of regional pathology within the evolving diagnostic landscape in England. Notable recommendations included improved communication and education, active stakeholder engagement, and tackling informatics barriers.
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Affiliation(s)
- Phillipe Taniere
- Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew G Nicholson
- Respiratory Pathology, National Heart and Lung Institute, Imperial College London, London, UK
- Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John R Gosney
- Cellular Pathology, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Danielle Bury
- Histopathology, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - David Allan Moore
- Cellular Pathology, University College London Cancer Institute, London, UK
| | - Eldo Verghese
- Histopathology, St James's University Hospital, Leeds, UK
| | - Irshad Soomro
- Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Leena Joseph
- Histopathology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nidhi Bhatt
- Cellular Pathology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Patrizia Viola
- Cellular Pathology, Imperial College Healthcare NHS Trust, London, UK
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Sheffield BS, Beharry A, Diep J, Perdrizet K, Iafolla MAJ, Raskin W, Dudani S, Brett MA, Starova B, Olsen B, Cheema PK. Point of Care Molecular Testing: Community-Based Rapid Next-Generation Sequencing to Support Cancer Care. Curr Oncol 2022; 29:1326-1334. [PMID: 35323313 PMCID: PMC8947443 DOI: 10.3390/curroncol29030113] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Biomarker data are critical to the delivery of precision cancer care. The average turnaround of next-generation sequencing (NGS) reports is over 2 weeks, and in-house availability is typically limited to academic centers. Lengthy turnaround times for biomarkers can adversely affect outcomes. Traditional workflows involve moving specimens through multiple facilities. This study evaluates the feasibility of rapid comprehensive NGS using the Genexus integrated sequencer and a novel streamlined workflow in a community setting. Methods: A retrospective chart review was performed to assess the early experience and performance characteristics of a novel approach to biomarker testing at a large community center. This approach to NGS included an automated workflow utilizing the Genexus integrated sequencer, validated for clinical use. NGS testing was further integrated within a routine immunohistochemistry (IHC) service, utilizing histotechnologists to perform technical aspects of NGS, with results reported directly by anatomic pathologists. Results: Between October 2020 and October 2021, 578 solid tumor samples underwent genomic profiling. Median turnaround time for biomarker results was 3 business days (IQR: 2-5). Four hundred eighty-one (83%) of the cases were resulted in fewer than 5 business days, and 66 (11%) of the cases were resulted simultaneously with diagnosis. Tumor types included lung cancer (310), melanoma (97), and colorectal carcinoma (68), among others. NGS testing detected key driver alterations at expected prevalence rates: lung EGFR (16%), ALK (3%), RET (1%), melanoma BRAF (43%), colorectal RAS/RAF (67%), among others. Conclusion: This is the first study demonstrating clinical implementation of rapid NGS. This supports the feasibility of automated comprehensive NGS performed and interpreted in parallel with diagnostic histopathology and immunohistochemistry. This novel approach to biomarker testing offers considerable advantages to clinical cancer care.
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Affiliation(s)
- Brandon S. Sheffield
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Andrea Beharry
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Joanne Diep
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Kirstin Perdrizet
- Division of Medical Oncology, William Osler Health System, Brampton, ON L6R 3J7, Canada; (K.P.); (M.A.J.I.); (W.R.); (S.D.); (P.K.C.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Marco A. J. Iafolla
- Division of Medical Oncology, William Osler Health System, Brampton, ON L6R 3J7, Canada; (K.P.); (M.A.J.I.); (W.R.); (S.D.); (P.K.C.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - William Raskin
- Division of Medical Oncology, William Osler Health System, Brampton, ON L6R 3J7, Canada; (K.P.); (M.A.J.I.); (W.R.); (S.D.); (P.K.C.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Shaan Dudani
- Division of Medical Oncology, William Osler Health System, Brampton, ON L6R 3J7, Canada; (K.P.); (M.A.J.I.); (W.R.); (S.D.); (P.K.C.)
| | - Mary Anne Brett
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Blerta Starova
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Brian Olsen
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Parneet K. Cheema
- Division of Medical Oncology, William Osler Health System, Brampton, ON L6R 3J7, Canada; (K.P.); (M.A.J.I.); (W.R.); (S.D.); (P.K.C.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
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