Shifting from clinician-ordered to pathologist-initiated reflex testing for NSCLC biomarkers combines diagnosis and molecular analysis into one workflow. This operational change minimizes delays, increases testing rates, and optimizes the use of small biopsy samples, getting actionable results to oncologists faster.

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.

To maximize the chances of successful biomarker identification from a liquid biopsy, especially when tissue is scant, the blood sample must be drawn before initiating any chemotherapy. This pre-treatment timing is critical for improving the diagnostic yield of blood-based next-generation sequencing (NGS) testing.

When considering escalating therapy for a patient with a high-risk p53 mutation, clinicians are adopting a key checkpoint: confirming the absence of a concurrent POLE mutation. The presence of a POLE mutation is thought to mitigate the aggressiveness of p53-mutated tumors, potentially making treatment escalation unnecessary.

Because PTEN loss is an early, truncal mutation in prostate cancer, clinicians should perform NGS testing on the first day a patient is seen. This proactive approach ensures that crucial biomarker information is not lost and is available to guide future treatment decisions, such as the use of an AKT inhibitor, should the disease progress.

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.

Clinicians increasingly perform Next-Generation Sequencing (NGS) on initial diagnostic tissue, even if results don't alter first-line treatment. This proactive approach identifies stable mutations like PIK3CA early, enabling long-term planning, such as optimizing a patient's metabolic health in anticipation of future targeted therapies.

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.

When an oncologist anticipates an initial sample (e.g., cytology) will likely have insufficient tissue for NGS testing, they proactively initiate a biopsy of a second site with interventional radiology. This parallel-path approach avoids waiting for the first test to fail, significantly reducing time to diagnosis and treatment.