Results from an online survey found that cancer care sites with standardized protocols and pathologist-ordered testing are more likely to adhere to clinical guidelines regarding comprehensive biomarker testing for patients with non-small cell lung cancer (NSCLC).

These data were first presented at the American Society for Clinical Pathology (ASCP) 2025 Annual Meeting in Orlando, Florida.

For patients with NSCLC, broad molecular panels for biomarker testing are recommended to guide therapy. Study authors noted that “reflex testing, ordered soon after diagnosis, speeds access to results and treatment.” To determine “workflow and policy barriers” that can lead to “inconsistent implementation,” the study authors conducted an online survey.

This online survey examined testing at diagnosis, reflex testing to multi-gene panels, and results delivered ≤21 days and before the first oncology consult. There were 115 respondents of which 43% were pathologists, 18% were molecular pathologists, 14% were nurses, 14% were advanced practitioners, 9% were laboratory directors or managers, 7% were laboratory or clinical science professionals, 3% were clinicians, and 3% were other. Additionally, 46% of the respondents were from academic centers, 45% were from community centers, 15% were government or tribal sites, and 9% were commercial reference laboratories.

While 73% of the respondents use multi-gene panels for NSCLC, only 66% currently utilize reflex testing, with a further 39% of non-standardized sites considering the adoption of such a protocol. There were 66 respondents whose sites have or are considering standardized protocol, 58% of which noting that pathologists are or will be the ordering physician for biomarker testing. Pathologist-ordered biomarker testing was more common at academic medical centers than community, government, or independent facilities. There were 55% of respondents who reported that more than 80% of patients with newly diagnosed NSCLC received comprehensive biomarker testing (87% of respondents with pathologist-ordered testing). Additionally, 52% reported that results were available within 14 to 21 days of diagnosis, and 36% reported that results were available before the first oncology consult (87% and 74% of respondents with pathologist-ordered testing, respectively). Of all the respondents, 91% noted that they believe cancer care improves when pathologists routinely order broad molecular panels based on multidisciplinary consensus. 

Study authors concluded that, while most sites do use multi-gene panels for patients with newly diagnosed NSCLC, “standardized reflex protocols are less common, highlighting opportunities to expand adoption and improve timely testing.” Additionally, while most respondents believed that pathologists ordering biomarker testing improved cancer cancer, they stipulatied “it should be guideline-driven” which suggest, according to study authors, “opportunities for societies to advocate and provide pathologist education.”

Study authors noted the future direction for this research as focus groups and the identification of optimal reflex workflow models for different settings.

Source:

Martin N, Temple-Smolkin R, Scrimenti A, et al. Understanding use of reflex biomarker testing at diagnosis in NSCLC: Results of an online survey. Presented at ASCP 2025 Annual Meeting; November 17-20, 2025. Orlando, Florida.