29. Patterns of EGFR mutation testing pre-and post-establishment of an in-house molecular pathology service

Abstract

<h3>Background</h3> Molecular testing of tumours is a rapidly growing area, with anatomical pathology laboratories being asked more frequently to use their material to perform molecular testing, either in-house or as a send-out test. In addition to the expense of the test itself, the retrieval and preparation of material for testing may be both time-consuming and labour-intensive, particularly if archives are not on-site or if a pathologist is required to re-examine the case to identify appropriate material. Limited information exists in the literature regarding adherence to guidelines, and without this information it is difficult to determine if the additional workload on laboratory personnel is justified. <h3>Aims</h3> To determine the timing, appropriateness and rates of EGFR mutation testing at the Austin and to identify any changes to these measures following establishment of an in-house service. <h3>Methods</h3> For EGFR mutation testing, specimen type, average request rates, turnaround times and test failure rates were determined for the 12 month period from January to December 2012. Following the establishment of in-house EGFR mutation testing, these rates were determined for the 3 month period of January to March 2013. <h3>Results</h3> EGFR tests were requested appropriately on all cases and were confined to cases of primary or metastatic lung adenocarcinoma only. Turnaround times improved significantly following introduction of in-house testing (average TAT time pre-introduc-tion, 39 days; average TAT post-introduction, 7 days). Request rates increased following introduction of in-house testing. Failure rates remained unchanged. <h3>Conclusions</h3> Although EGFR testing may have additional unaccounted-for costs for anatomical pathology laboratories, these costs are justified at the Austin by clinically-appropriate testing. Our data confirms increasing request rates although the additional convenience of in-house availability and more rapid TATs may also be contributing factors.