Webinar: Molecular Testing for NSCLC with Rapid Tissue-Based NGS

Webinar presenter

Lauren Ritterhouse, MD, PhD
Associate Director, Center for Integrated Diagnostics, Massachusetts General Hospital
Assistant Professor, Pathology, Harvard Medical School

Dr. Ritterhouse joined the Massachusetts General Hospital Department of Pathology and Center for Integrated Diagnostics as a staff pathologist in 2019. She completed a Molecular Genetic Pathology Fellowship at Harvard Medical School and Anatomic Pathology Residency at Brigham and Women’s Hospital in Boston, MA. She is particularly interested in the translation of emerging molecular biomarkers into the clinical laboratory, including those evaluating response to immunotherapy, solid tumor mutational signature profiling, circulating tumor DNA, as well as hematologic malignancies.

Webinar summary

This webinar, hosted by CAP Today, focuses on how rapid next-generation sequencing (NGS) in lung cancer is enabling clinicians and reducing biomarker testing costs. The session features a multidisciplinary perspective from pathology and medical oncology experts, Dr. Lauren Ritterhouse, MD, PhD from Massachusetts General Hospital. The discussion centers on improving molecular testing workflows in non-small cell lung cancer (NSCLC) within the context of precision medicine.

Study overview

The webinar presents the development and clinical implementation of a rapid, tissue-based NGS testing program designed to bridge the gap between traditional rapid molecular assays like PCR-based tests and comprehensive genomic profiling.

Historically:

Rapid PCR-based assays offer fast turnaround (hours to days) but are limited to a small number of known mutations.
Comprehensive genomic profiling (NGS) provides broad mutation detection but has longer turnaround times (typically weeks) and higher complexity.

The presented rapid NGS approach aims to combine speed with broader genomic coverage:

A 50-gene panel targeting actionable mutations in lung cancer
Detection of single nucleotide variants, insertions/deletions, fusions, and copy number alterations
Automated workflow including extraction, sequencing, and analysis
Runtime of ~16–18 hours with next-day results
Minimal tissue requirements suitable for small biopsy samples

The program also incorporates an “ultra-rapid” clinical workflow:

Use of fresh/frozen biopsy tissue to initiate testing immediately
Multidisciplinary coordination across pathology, oncology, radiology, and pharmacy
Integration of specialty pharmacy to reduce delays in treatment initiation

Key findings

Improved efficiency and resource utilization

~90% reduction in hands-on technician time compared to legacy workflows
~75% reduction in pathologist review time
50% reduction in reagent costs
Simplified training due to automation

Rapid turnaround time

Molecular results available within 24–48 hours (vs. ~1 week or longer with traditional methods)
Time from test order to treatment initiation reduced to 3–5 days, with some patients treated within 48 hours

Strong technical performance

<1% assay failure rate
99% specificity for targeted variants and 100% specificity for fusion detection
Sensitivity of 95% with detection down to 5% allele frequency

High clinical utility

Driver alterations identified in 75% of NSCLC cases
Detection of additional actionable mutations not captured by legacy single-gene assays
RNA component identified fusions (e.g., ALK, RET, MET exon 14 skipping) in ~14% of cases

Supporting clinical decision-making

Enables appropriate therapy selection before treatment initiation
Helps avoid ineffective or harmful treatments (e.g., immunotherapy in certain molecular subtypes)
Supports biomarker-driven therapy in both advanced and early-stage disease
Facilitates faster initiation of targeted therapies, improving patient management timelines

Multidisciplinary workflow is critical

Success depends on coordination between oncology, pathology, interventional teams, and pharmacy

Implementation requires institutional buy-in, education, and iterative process development

Conclusion

Rapid NGS testing represents an effective approach to combining speed and genomic breadth in molecular diagnostics for NSCLC. The implemented workflow demonstrates that it is possible to deliver comprehensive biomarker results within clinically actionable timeframes.

This approach:

Addresses limitations of both traditional rapid assays and slower comprehensive profiling
Improves efficiency, reduces costs, and enhances laboratory workflow
Enables timely, biomarker-driven treatment decisions
Supports the expanding role of precision medicine across both advanced and early-stage lung cancer

Overall, rapid and comprehensive molecular testing is becoming essential for modern lung cancer care, and multidisciplinary collaboration is key to successful implementation.