Accelerating answers: Impact of a quality improvement initiative for lung cancer pathology practices at the VA.

Abstract

e23228 Background: Advances in lung cancer biology have enabled targeted therapies for patients with driver mutations. Pathology lab processes are critical in delivering timely molecular data to guide therapy selection. This study evaluated the impact of two pathology interventions on sample processing time and therapy initiation. Methods: A retrospective analysis of all lung cancer biopsies between 2015-2024 at several southwestern Veterans Affairs Medical Centers was conducted. Two pathology lab interventions were implemented during this time to streamline sample processing: (1) whole-block cutting at the time of biopsy, rather than step-by-step cutting as tests are ordered and (2) replacing send-out with in-house next generation sequencing (NGS). Primary endpoints included the number of samples with insufficient quantity to perform FISH and the turn-around-time (TAT) from biopsy to reporting of all genetic data. Secondary endpoints included time from biopsy to first therapy in Stage IV patients. Statistical analysis for nonparametric distributions was performed accordingly. Results: 1302 samples were included in the initial analysis. After the block-cutting intervention, the proportion of these samples with insufficient quantity to perform FISH decreased by half (9.8% vs 4.2%, p < 0.0001). Detailed chart review was then undertaken for the 352 patients at the largest VA, encompassing 381 biopsy samples. Mean patient age was 70, 97% were male, and 95% used tobacco. Most samples were obtained via core biopsy (61%), surgical excision (17%), or endobronchial ultrasound (12%). Histology was consistent with lung adenocarcinoma in 89% of cases. TAT from biopsy to genetic data improved with each intervention (26d vs 20d vs 19d, p < 0.0001). In Stage IV patients, time to first therapy was significantly reduced after implementation of in-house NGS (49d vs 30d, p < 0.01). Time from biopsy to first therapy did not differ significantly by racial or ethnic group. Conclusions: Implementation of two pathology interventions—complete block cutting at time of biopsy, and in-house NGS—reduced the number of inadequate samples and improved time to data completion and therapy initiation in lung cancer patients. Reevaluating existing pathology protocols can enhance precision oncology.