Molecular Testing Information

Test NameTumorApproved UseOrdered ByOrdering Comment
Androgen ReceptorsBreastTriple-neg breast cancersONC
BRAF MutationMelanomaStage IV melanomas (not I-III)ONC
BRAF MutationLungCan order if EGFR, EML4, ALK, ROS1 and PD-L1 are negative, and patient is a NON-SMOKER.ONC
BRAF MutationThyroidPrognostic for papillary carcinomaONC
ENDOCRINE
Breast Cancer IndexBreastNOT APPROVED
Cancer Type IDColonNOT APPROVED
Cancer Type IDTumor of Unknown PrimaryNOT APPROVED
Test under investigation
Use clinical data and history to find primary.
C-Kit MelanomaMelanomaAcral and Mucosal melanoma
Not for other types
ONC
ConfirmMDxNOT APPROVEDUrologists seeking its approval
Caris Molecular IntelligenceNOT APPROVED
Double-hit Lymphoma
FISH MYC BCL
LymphomaDiffuse Large B-cell LymphomaONC
HEMEPATH
Only perform if not a typical diffuse large B-cell lymphoma
Foundation OneNOT APPROVED
Her2 (IHC)BreastInvasive ductal and lobular.PATHREFLEX
Her2 (IHC)StomachGastric carcinomaONC
EGFR -> EML4 -> ALK -> ROS-1 (mol)
and PD-L1 (IHC)
LungLUNG Adeno, adenosquamous and NSCCa-NOS in NON-SMOKERS
NOT for squamous or small cell
ONCROS-1 must be specified in Tapestry.
If all negative, BRAF may be done by ONC request
Unstained slides (if core) and block sent to facility, then to Quest.
EGFR -> EML4 -> ALK -> ROS-1 (mol)
and PD-L1 (IHC)
LungLUNG Squamous cell ca in NON-SMOKERS
NOT for smokers
ONCROS-1 must be specified in Tapestry.
If all negative, BRAF may be done by ONC request
Unstained slides (if core) and block sent to facility, then to Quest.
EGFR -> EML4 -> ALK (mol)
and PD-L1 (IHC)
or
KRAS -> EGFR -> EML4 -> ALK (mol)
and PD-L1 (IHC)
LungLUNG Adeno, adenosquamous and NSCCa-NOS in SMOKERS
NOT for squamous or small cell; NOT for non-smokers
ONCUnstained slides (if core) and block sent to facility, then to Quest.
KRAS may be ordered up front (KRAS and EGFR are mutually exlcusive)
GeneStrat EGFR T790M Assay (blood test)LungLUNG Non-small cell ca with acquired EGFR-TKI resistanceONCSend test to ARUP
KRAS, NRAS and BRAFColonCOLON metastatic cancerONC
MRD (Minimal Residual Disease)LeukemiaLEUKEMIA ALL and AMLONCTwo purple tops drawn at end of induction period (Day 29). Send one for regular flow cytomery, send other to Univ. of Washington for MRD testing using a 10-marker panel.
MRP (Mismatch Repair Protein) (IHC)ColonCOLORECTAL adenocarcinomaPATHREFLEX on biopsy.
Order on metastasis ONLY if not already done on primary.
KRAS with Reflex NRAS and BRAF
if MRP mutation NEG
ColonCOLORECTAL adenocarcinomaREGIONALReflex based on MRP result
KRAS with Reflex NRAS (no BRAF)
if MRP mutation POS
ColonCOLORECTAL adenocarcinomaREGIONALReflex based on MRP result
MRP (Mismatch Repair Protein) (IHC)EndometriumENDOMETRIAL carcinomaPATHReflex on biopsy
MRP (Mismatch Repair Protein) (IHC)SebaceousSEBACEOUS lesions other than hyperplasia (patient <65 or with fam hx or signs of Muir-Torre)DERMPATHIf <65 and no suspicous for Muir-Torre, don't need to send to Cassarino.
MSI (Microsatellite Instability)GENETICS
Oncotype DXBreastDCIS From lumpectomy to determine need for radiationRAD-ONC
Oncotype DXBreastInvasive duct/lobular
ER+ Node-
ER+ Her2- Node(1-3)+
NOT if ER- or ER+ Node(>3)+ or ER+ Her2+
ONC
Oncotype DXColonNOT APPROVED
Oncotype DXProstateNOT APPROVED
Oncogenic CSF3R MutationLeukemiaCML and atypical CML for patients who might take RuxolotinibONC
p16OropharynxSqamous carcinoma
Not for Oral cavity, laryngeal, nasopharynx or sinonasal primary tumors
PATHREFLEX
CMET (IHC)StomachNOT APPROVED
ER beta subunitMelanomaNOT APPROVED
1p19q del (FISH)BrainLow-grade glioma
Not for GBM
NEUROPATHREFLEX
MGMTBrainLow-grade gliomas and GBMPATHREFLEX
IDH1 (IHC)BrainLow-grade gliomas and GBMNEUROPATHREFLEX
IDH1 (PCR)BrainNOT APPROVED
IDH1/2BrainLow-grade gliomas when IDH1(-) by IHCNEUROPATHREFLEX
PD-L1 (PCR)LungNon-small cell carcinomasOrder as Other-Outside IHC. In comment, state drug that patient is on (either Opdivo or Keytruda). Scan report into Media tab.
PD-L1OtherAfter discussion between path and oncONCGastric (prognostic): Send to Quest, requesting to be sent to Chantilly (test code 94007)
ProlarisNOT APPROVED
TERTBrainNOT APPROVED
450K arrayBrainNOT APPROVED