Vijayalakshmi Padmanabhan, MD; Heather B. Steinmetz, BS; Elizabeth J. Rizzo, BS; Amber J. Erskine, BS; Tamara L. Fairbank, BS; Francine B. de Abreu, PhD; Gregory J. Tsongalis, PhD; Laura J. Tafe, MD From the Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Dr Padmanabhan is now with the Department of Pathology, Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas. (2017) Improving Adequacy of Small Biopsy and Fine-Needle Aspiration Specimens for Molecular Testing by Next-Generation Sequencing in Patients With Lung Cancer: A Quality Improvement Study at Dartmouth-Hitchcock Medical Center. Archives of Pathology & Laboratory Medicine: March 2017, Vol. 141, No. 3, pp. 402-409.

ORIGINAL ARTICLES

Improving Adequacy of Small Biopsy and Fine-Needle Aspiration Specimens for Molecular Testing by Next-Generation Sequencing in Patients With Lung Cancer: A Quality Improvement Study at Dartmouth-Hitchcock Medical Center

Vijayalakshmi Padmanabhan, MD; Heather B. Steinmetz, BS; Elizabeth J. Rizzo, BS; Amber J. Erskine, BS; Tamara L. Fairbank, BS; Francine B. de Abreu, PhD; Gregory J. Tsongalis, PhD; Laura J. Tafe, MD

From the Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Dr Padmanabhan is now with the Department of Pathology, Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas.

Reprints: Laura J. Tafe, MD, Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756 (email: Laura.J.Tafe@Hitchcock.org).

The authors have no relevant financial interest in the products or companies described in this article.

A portion of the data was presented at the 2015 Association for Molecular Pathology annual meeting; November 6, 2015; Austin, Texas.

Context.— At our medical center, cytopathologists perform rapid on-site evaluation for specimen adequacy of fine-needle aspiration and touch imprint of needle core biopsy lung cancer samples. Two years ago the molecular diagnostics laboratory at our institution changed to next-generation sequencing using the Ion Torrent PGM and the 50-gene AmpliSeq Cancer Hotspot Panel v2 for analyzing mutations in a 50-gene cancer hot spot panel. This was associated with a dramatic fall in adequacy rate (68%).

Objective.— To improve the adequacy rate to at least 90% for molecular testing using next-generation sequencing for all specimens collected by rapid on-site evaluation by the cytology laboratory.

Design.— After baseline data on adequacy rate of cytology specimens with rapid on-site evaluation for molecular testing had been collected, 2 changes were implemented. Change 1 concentrated all the material in one block but did not produce desired results; change 2, in addition, faced the block only once with unstained slides cut up front for molecular testing. Data were collected in an Excel spreadsheet and adequacy rate was assessed.

Results.— Following process changes 1 and 2 we reached our goal of at least 90% adequacy rate for molecular testing by next-generation sequencing on samples collected by rapid on-site evaluation including computed tomography–guided needle core biopsies (94%; 17 of 18) and fine-needle aspiration samples (94%; 30 of 32).

Conclusion.— This study focused on factors that are controllable in a pathology department and on maximizing use of scant tissue. Optimizing the adequacy of the specimen available for molecular tests avoids the need for a second procedure to obtain additional tissue.