# Utility of a Novel High‐Sensitivity Multiplex Companion Diagnostic Test Using Formalin‐Fixed Paraffin‐Embedded Cell Block Materials of Non‐small Cell Lung Cancer

## TL;DR

A new high-sensitivity diagnostic test for lung cancer works well with low-quality tissue samples, improving detection of mutations in difficult cases.

## Contribution

The study introduces and validates a high-sensitivity companion diagnostic test (cPANEL) for low tumor content FFPE cell block samples.

## Key findings

- cPANEL detected EGFR mutations in 68.8% of low tumor content FFPE-CB samples.
- cPANEL outperformed single-CDx in mutation detection rate for low tumor content samples.
- Over 60% of FFPE-CB samples had tumor content below 10%, yet cPANEL still provided useful results.

## Abstract

Formalin‐fixed paraffin‐embedded (FFPE) tissue is the standard material for companion diagnostic tests (CDx). Although cytological specimens can be useful, their low tumor content (TC) poses challenges. Recently, a high‐sensitivity CDx, the “Lung Cancer Compact Panel (cPANEL),” with a recommended TC of 5%, was introduced into clinical practice. This CDx achieves high detection sensitivity by selecting specific genes for analysis, processing them separately, and performing sequence at sufficient depth. This approach enables the detection of mutations even when they are present in only small amounts within the sample. This study aimed to evaluate the utility of cPANEL using FFPE cell block (CB) with a low TC.

We analyzed FFPE‐CB pleural fluid samples from 26 patients diagnosed with malignant pleural effusion originating from lung adenocarcinoma. TC was quantified using AI‐equipped image analysis software, and samples with a TC of less than 10%—the minimum threshold for single‐CDx—were selected for CDx analysis. To confirm that cPANEL has better sensitivity than single‐CDx, which has high detection power, and that it is advantageous in low TC samples such as FFPE‐CB, we compared the two CDx assays based on the EGFR‐positive rate using samples that did not meet the TC criterion for single‐CDx.

Most FFPE‐CB had low TC levels, with only approximately 27% meeting the TC criteria for the widely used multi‐CDx. Furthermore, over 60% of the samples fell below the 10% threshold for a single‐CDx. Despite the low TC, EGFR mutations were partially detected, with cPANEL achieving a higher detection rate than that of single‐CDx (68.8% vs. 50.0%).

Although cPANEL is classified as a multi‐CDx, it demonstrated superior sensitivity compared with that of single‐CDx. It proved effective even for FFPE‐CB samples with very low TC, making it a promising tool to enhance the use of cytological samples for CDx in the future.