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Predictive molecular pathology in the time of coronavirus disease (COVID-19) in Europe
  1. Umberto Malapelle1,
  2. Pasquale Pisapia1,
  3. Antonino Iaccarino1,
  4. Massimo Barberis2,
  5. Claudio Bellevicine1,
  6. Hans Brunnström3,
  7. Dario de Biase4,
  8. Giovanna De Maglio5,
  9. Kajsa Ericson Lindquist3,
  10. Matteo Fassan6,
  11. Gabriella Fontanini7,
  12. Elisa Gruppioni8,
  13. Paul Hofman9,
  14. Sabine Merkelbach-Bruse10,
  15. Miguel A Molina Vila11,
  16. Anaïs Pujals12,
  17. Ida Rapa13,
  18. Luisella Righi14,
  19. Rafael Rosell15,
  20. Oliver Schildgen16,
  21. Verena Schildgen16,
  22. Fernando C Schmitt17,
  23. Giovanni Tallini8,
  24. Sara Vander Borght18,
  25. Elena Vigliar1,
  26. Marco Volante14,
  27. Svenja Wagener-Ryczek10,
  28. Birgit Weynand18,
  29. Giancarlo Troncone1
  1. 1 Department of Public Health, University of Naples Federico II, Naples, Italy
  2. 2 Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
  3. 3 Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
  4. 4 Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
  5. 5 Department of Pathology, University Hospital of Udine, Udine, Italy
  6. 6 Surgical Pathology Unit, Department of Medicine, University of Padua, Padua, Italy
  7. 7 Department of Surgical, Medical, and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
  8. 8 Department of Pathology, University of Bologna Medical Center, Bologna, Italy
  9. 9 Pathology, INSERM, Nice, France
  10. 10 Institute of Pathology, University of Cologne, Cologne, Germany
  11. 11 Laboratory of Oncology, Pangaea Oncology, Barcelona, Spain
  12. 12 Department of Pathology, CHU Henri Mondor, Creteil, France
  13. 13 Pathology Unit, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
  14. 14 Pathology Unit, Department of Oncology, University of Turin, Turin, Italy
  15. 15 Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology; Germans Trias i Pujol Health Sciences Institute and Hospital Badalona, Barcelona, Spain
  16. 16 Institute of Pathology, Hospital of the Private University Witten/Herdecke, Cologne, Germany
  17. 17 Pathology, IPATIMUP and Medical Faculty of Porto, Porto, Portugal
  18. 18 Department of Pathology, University Hospitals Leuven, Leuven, Belgium
  1. Correspondence to Professor Giancarlo Troncone, Public Health, University of Naples Federico II, Naples 80131, Italy; giancarlo.troncone{at}


Aims Lung cancer predictive biomarker testing is essential to select advanced-stage patients for targeted treatments and should be carried out without delays even during health emergencies, such as the coronavirus (COVID-19) outbreak.

Methods Fifteen molecular laboratories from seven different European countries compared 4 weeks of national lockdown to a corresponding period in 2019, in terms of tissue and/or plasma-based molecular test workload, analytical platforms adopted, number of cases undergoing programmed death-ligand1 (PD-L1) expression assessment and DNA-based molecular tests turnaround time.

Results In most laboratories (80.0%), tissue-based molecular test workload was reduced. In 40.0% of laboratories (6/15), the decrease was >25%, and in one, reduction was as high as 80.0%. In this instance, a concomitant increase in liquid biopsy was reported (60.0%). Remarkably, in 33.3% of the laboratories, real-time PCR (RT-PCR)-based methodologies increased, whereas highly multiplexing assays approaches decreased. Most laboratories (88.9%) did not report significant variations in PD-L1 volume testing.

Conclusions The workload of molecular testing for patients with advanced-stage lung cancer during the lockdown showed little variations. Local strategies to overcome health emergency-related issues included the preference for RT-PCR tissue-based testing methodologies and, occasionally, for liquid biopsy.

  • pathology
  • molecular
  • molecular biology
  • lung neoplasms
  • biomarkers
  • tumour

Data availability statement

All data relevant to the study are included in the article.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

All data relevant to the study are included in the article.

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  • Handling editor Runjan Chetty.

  • Twitter @UmbertoMalapel1, @PasqualePisapia

  • UM, PP and AI contributed equally.

  • Contributors UM, PP, AI and GTr conceived the study and wrote the manuscript. All authors collected the data, reviewed and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Competing interests UM reports personal fees (as speaker bureau or advisor) from Boehringer Ingelheim, AstraZeneca, Roche, MSD, Amgen, Merck and BMS. GTr reports personal fees (as speaker bureau or advisor) from Roche, MSD and Pfizer.

  • Provenance and peer review Not commissioned; externally peer reviewed.