Lung Cancer Biomarker Testing

Oncologists  |  Physicians Performing Diagnostic Procedures  |   Pathologists Outside Calgary Zone

Calgary Zone

Requests from Oncologists

Oncologists and Radiation Oncologists may request Lung Cancer Biomarker testing when a patient has not been previously tested or has been tested and the response to treatment has changed or a new lesion has appeared.

It is the responsibility of the requesting physician to provide the following:

• Accurate patient information including AB Health #, location of tumor, sample type, etc.
• Accurate physician information
• Type of malignancy (if known)
• Stage of cancer
• Previous biomarker test result (if previously performed)

Oncologists may request biomarker testing on previously performed biopsy/cytology specimens by completing Referral of Pathology Material - Oncology APCY1006C and faxing to the Calgary Laboratory Consult Desk at Foothills Medical Centre (Phone: 403-944-4542; Fax 403-944-4748).

Oncology may request biomarker tests on patients from outside Calgary Zone. However, please note the biopsy material may exist in that zone and it is best for the primary pathologist to initiate testing.

Results Availability:

All pathology results, including biomarker tests, are available on NetCare soon after the results are verified. Specific tests are performed in different parts of the lab and take 2-3 days for the test (sometimes batch tested); please allow time for transportation of material.

To contact the primary reporting pathologist, please see the bottom of the report (name, phone/pager).

It is best to communicate with the primary pathologist regarding all questions related to the report.

If a report is required, please call the Laboratory Information Centre (phone 403-770-3600).

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Requests from Physicians Performing Diagnostic Procedures

Physicians (Pulmonologists, Interventional Radiologists, and Thoracic Surgeons) may request biomarker tests on samples they obtain for diagnostic or therapeutic purposes. It is important the following information is provided:

• MUST provide accurate patient information (AB Healthcare number, full first and last name)
• MUST document the time the tissue was immersed in formalin
• MUST provide Type of malignancy
• MUST provide Stage of cancer
• MUST provide name of Oncologist (if available)

The appropriate requisition MUST accompany the specimen, which should be placed in the correct preservative.

Cytology specimens should be placed in Cytolyt container and REQ9041CY-NON Non-Gynecological Cytopathology Requisition must be completed. If a separate tissue biopsy in formalin is taken together with cytology samples, the specimens are kept together to avoid duplicate testing. The text "Send to DSC Cytology, Suspected Advanced Malignancy, Formalin Fixation" should be placed on the accompanying requisition.

A biopsy specimen (cutting needle, large bore needle, core biopsy, etc.) must be placed in a properly labeled formalin container and a REQ9032AP Anatomic Pathology Acute Care Requisition must be completed.

Notes:

• A cell block can be prepared and biomarker testing performed if adequate cellularity is present in the Cytology specimen.
• Biopsy tissue specimens are best suited for biomarker testing.
• PD-L1 is currently not validated for Cytolyt fixed cytology specimens.
• If the physician name is not provided or is incomplete, they will NOT receive a copy of the report.
• The specimen and patient information on the container must match the information on the requisition.
• Effusion fluids collected in large volumes can yield adequate cellular material for diagnosis. However, if not sent to the laboratory right away, the specimen should be refrigerated.
• Large 500 mL or 1 L vacuum sealed collection containers are tamper proof but difficult for removing fluid samples for testing. Often there are clots present that trap cells and are hard to drain from the narrow opening. It is strongly advised to collect 150-250 mL sample in sterile urine containers or a sterile larger container to submit fluid specimens for testing.

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Requests from Pathologists Outside Calgary Zone

Pathologists from outside the Calgary zone may request biomarker testing on specimens originating in their zone.
Submit the request to:

The CLS Consult Desk
 Foothills Medical Centre,
7th floor McCaig Tower (Phone: 403-944-4542; fax: 403-944-4748)

It is the responsibility of the primary pathologist in the zone requesting the biomarker test to ensure the appropriate clinical information is provided, patient ID is confirmed, specimen and requisitions are correctly labeled and NSCLC is confirmed.

The requesting pathologist:

• MUST submit a CLS REQ9038AP Molecular Pathology Requisition for lung cancer biomarker test.
• MUST submit the most suitable block AND indicate the block number on the requisition.
• MUST provide an H & E slide of the same block AND circle the viable tumor area with a permanent marker on the slide.
• MUST indicate the percentage (%) of tumor cells on the requisition.
• MUST indicate the name of the clinician and requesting pathologist.
• If PD-L1 testing is ordered (alone or in addition to ALK and/or EGFR testing), the requesting pathologist is responsible for sending 4 unstained Superfrost slides to Edmonton with Edmonton Zone Regional Immunohistochemistry Request Form RAPIPF16000 and a copy of the original report.
• Submit the request and slide/block to the Consult Desk at FMC.

Edmonton Zone

• Clinician Lung Biomarker Requesting Process

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