TABLE IV.

Recommendations

Step 1	Establish clear clinical guidance for pathologists and other clinicians involved in lung cancer diagnosis and treatment about molecular testing in lung cancer. The guidance should include the population to be tested, timing, and tests to be performed. International and national guidelines must be adapted for local use.
Step 2	Ensure that diagnostic requisitions from respirologists, thoracic surgeons, and interventional radiologists indicate whether there is clinical suspicion of primary lung cancer, other cancer history, and other samples collected (and tested) previously or planned (for example, pending surgical resection).
Step 3	To facilitate molecular testing, pathologists have to incorporate routine EGFR and ALK testing into the diagnostic lung cancer algorithm, minimizing unnecessary sections and immunohistochemistry. As with HER2 testing in breast cancer, molecular testing in lung cancer should be funded through provincial health care systems and should be considered routine.
Step 4	Clearly establish and monitor turnaround times: guidelines from the Canadian Association of Pathologists recommend 3 days for transport from diagnosing lab to the molecular testing lab, followed by a 10-day turnaround for results to be delivered to the ordering pathologist and clinician.
Step 5	Provide feedback to clinicians about tissue volume, quality, whether testing was successful, and molecular results in a timely manner. Provincial or national molecular databases (or both) should be maintained to ensure that molecular testing is performed for all appropriate patients.