Molecular Testing in Anatomic Pathology and Adherence to Guidelines: A College of American Pathologists Q-Probes Study of 2230 Testing Events Reported by 26 Institutions

Abstract

Context The appropriate and timely performance of molecular testing in anatomic pathology is an indicator of quality. The National Comprehensive Cancer Network (NCCN) publishes a comprehensive treatment guideline that includes recommendations for ancillary testing. Objective To establish benchmarks for rates of adherence to NCCN testing recommendations through a multi-institutional study. Design Participants in a 2013 Q-Probes study of the College of American Pathologists reported data from molecular testing on anatomic pathology cases, excluding hematolymphoid neoplasms, breast primary carcinomas, and gynecologic cytology. Results Twenty-six institutions reported data from 2230 molecular testing events. In a retrospective study limited to colon, lung, and melanoma, there was strict adherence to guidelines in a median 71% (10th to 90th percentile range, 33%–90%) and there was at least loose adherence in a median 95% (10th to 90th percentile range, 57%–100%). There was adequate tissue to complete testing in a median 98% (10th to 90th percentile range, 86%–100%); in aggregate the adequacy rate for cell blocks was lower (84%, P < .001). Median test turnaround time was 8 days (10th to 90th percentile range, 4–13 days). In a prospective collection of all organ sites, there was strict adherence to guidelines in a median 53% (10th to 90th percentile range, 20%–71%), and there was at least loose adherence in a median 94% (10th to 90th percentile range, 75%–100%). Adherence to guidelines was higher for lung specimens and in institutions with more multidisciplinary conferences. Conclusions This multi-institutional study provides benchmarking data on appropriateness and timeliness of molecular testing in anatomic pathology.