Integrating next-generation sequencing (NGS) as standard of care in the management of early-stage non-small cell lung cancer (NSCLC): A quality imperative.

498 Background: NGS remains underutilized in early-stage NSCLC which results in missed opportunities to personalize therapy. Timely molecular profiling is critical to ensure actionable results are available prior to multidisciplinary planning. Institutional studies suggest that preoperative NGS on biopsy specimens does not delay perioperative care, however, widespread adoption remains inconsistent. Methods: We conducted a retrospective review of 50 patients with stage IB–IIIB NSCLC who underwent surgical resection at the Zuckerberg Cancer Center. Charts were reviewed for referral to medical oncology prior to surgery, discussion of neoadjuvant chemo-immunotherapy, and presentation at tumor board. This submission presents pre-intervention data. We plan to distribute surveys and conduct multidisciplinary focus groups to understand barriers to early referral and biopsy. Using quality improvement tools such as Pareto charts and fishbone diagrams, we will identify root causes affecting workflow adherence. This will inform Plan-Do-Study-Act cycles aimed at refining process improvements. Results: Among the 50 patients reviewed: 23 patients (46%) were referred to medical oncology prior to surgery, 17 patients (34%) were presented at tumor board, 23 patients (46%) underwent biopsy prior to surgery, 24 patients (48%) received NGS testing and 17 patients (34%) received neoadjuvant therapy. A stage-specific breakdown is provided in Table 1. Fewer than half of patients underwent biopsy before surgery, limiting access to targeted neoadjuvant strategies. Conclusions: Our study demonstrates underutilization of guideline-concordant care—including early medical oncology referral, tumor board presentation, and pre-surgical NGS testing—for resectable stage IB–IIIB NSCLC at a high-volume academic center. These gaps mirror national trends; recent data show <3% utilization of neoadjuvant therapy in stage I and only 40% in stage III. These findings highlight the need for quality improvement initiatives to align local practice with emerging standards of care. At Northwell, we are creating a workflow that streamlines acquiring and applying NGS data within 3 weeks of pre-surgical biopsy. Given global underuse of perioperative therapies for resectable lung cancer, our approach may serve as a model for broader implementation across institutions. Management approach by stage. Stage Patients Medical Onc referral before surgery Presented to TB before surgery Neoadjuvant Treatment Biopsy before surgery NGS testing before surgery IB 9 2 (22.2%) 1 (11.1%) 0 (0.0%) 1 (11.1%) 2 (22.2%) IIA 3 0(0.0%) 2 (66.7%) 0 (0.0%) 3 (100.0%) 0 (0%) IIB 14 7 (50.0%) 3 (21.4%) 4 (28.6%) 7 (50.0%) 6 (42.8%) IIIA 19 10 (52.6%) 7 (36.8%) 9 (47.4%) 9 (47.4%) 13 (68.4%) IIIB 5 4 (80.0%) 4 (80.0%) 4 (80.0%) 3 (60%) 3 (60%) Total 50 23 (46%) 17 (34%) 17 (34%) 23 (46%) 24 (48%)