Comprehensive molecular testing (PD-L1, EGFR, ALK) is no longer reserved for advanced disease. It is now critical for all patients with stage 1B or higher resectable NSCLC *before* starting any treatment to guide neoadjuvant and adjuvant therapy decisions.

While liquid biopsies are a valuable, less invasive tool, a negative result is inconclusive for ruling out actionable mutations in NSCLC. It may simply mean the tumor isn't shedding enough DNA. Therefore, a negative liquid biopsy should never be the final word; it must be followed by a tissue biopsy to ensure patients don't miss out on targeted therapies.

To reduce treatment delays, pathologists should initiate biomarker testing reflexively. Waiting for a medical oncologist to order tests at a first visit is a system failure, wasting critical time and risking the need to retrieve archived samples.

Effective collaboration for fast-moving small cell lung cancer shouldn't wait for a referral. Dr. Cooper advocates for a systems-level protocol where the pathologist's diagnosis itself triggers an immediate alert (e.g., a page) to the entire multidisciplinary team to enable rapid, coordinated planning from the moment of diagnosis.

Establishing a multi-disciplinary molecular tumour board helps operationalize biomarker strategies. This collaborative body, including oncologists and surgeons, not only interprets complex molecular data for trial matching but also collectively advocates for health insurance reimbursement for necessary tests, addressing a key practical barrier.

Unlike rare biomarkers that necessitate a 'test-and-wait' approach, IB6 is expressed in over 80-90% of NSCLC tumors. This ubiquity could make pre-screening unnecessary for drugs like Sigvotatug Vedotin, allowing clinicians to initiate targeted therapy much faster and for a broader patient population.

Clinicians ordering "NGS for lung" often misunderstand that Next-Generation Sequencing alone does not cover all actionable biomarkers, such as PD-L1 or HER2. This requires pathologists to interpret the clinician's intent and order a more comprehensive and appropriate test panel.

Data shows an average two-week delay occurs between a lung cancer patient's biopsy and the ordering of essential biomarker tests. This administrative gap, separate from the diagnostic process itself, is a major bottleneck that postpones critical treatment decisions.

To integrate RNA sequencing, labs can use a sequential workflow (DNA-NGS first, then RNA-NGS on driver-negative cases), which is cost-effective but slower. Alternatively, upfront co-testing is faster and decision-free but more expensive and may be unnecessary for patients with common DNA-level drivers.