Challenges in molecular testing: overcoming sample limitations in NSCLC

Context

L.G. is a 71-year-old retired accountant who began experiencing symptoms associated with lung cancer, including shortness of breath and persistent cough. Concerned about his symptoms, he sought medical help from his primary care physician, who noted a large pleural effusion and pleural nodularity by imaging. A pleural fluid sample was aspirated, and a cell block was made; however, it was deemed insufficient for molecular studies due to low cellularity. Histology and immunohistochemistry analysis of the cell block were consistent with lung cancer (non-small cell carcinoma).  A ctDNA test detected a TP53 variant at low variant allele frequencies, indicating a low tumor fraction and reducing the likelihood of identifying actionable mutations.