Reflex testing in this institution applied only to EGFR and KRAS mutations and ALK rearrangement. In this patient, additional studies were desired by the oncologist. The tumor was negative for KRAS and for secondary EGFR mutations, and for PIK3CA mutation but showed c-MET amplification. No ALK rearrangement was noted.

Because currently used molecular markers may be requested even though their impact on clinical outcomes is unclear, the issue of standardizing the molecular testing process was discussed in the multidisciplinary lung cancer conference. The team created a form to accompany all lung cancer patients to their appointments with oncologists, surgeons, interventional radiologists and pulmonologists. The molecular markers included on this form were debated. Other elements included on the form were whether cytology or histology specimens were obtained, the quality of the specimen, and the quantity of adequate specimen for testing. The team decided to individualize the choice of referral molecular laboratories.