NGS for (Hemato-) Oncology in Belgium: Evaluation of Laboratory Performance and Feasibility of a National External Quality Assessment Program

SIMPLE SUMMARY: In recent years, high-throughput sequencing has been routinely used by medical laboratories to search for somatic mutations in (hemato-)oncology as diagnostic, prognostic or therapeutic markers in various cancers. Since 2016, Belgium has developed a comprehensive program to facilitate the implementation of this technology in the national healthcare system, requiring, among others, an external quality assessment (EQA) of laboratories using this technology. Three benchmarking trials were organized between 2017 and 2018, covering different pathologies to establish the state of the art of the current practices of the Belgian laboratories and prepare future EQA. This study has highlighted areas of improvement for laboratories and will serve as a baseline for the establishment of a sustainable national EQA. ABSTRACT: Next-generation sequencing (NGS) is being integrated into routine clinical practice in the field of (hemato-) oncology to search for variants with diagnostic, prognostic, or therapeutic value at potentially low allelic frequencies. The complex sequencing workflows used require careful validation and continuous quality control. Participation in external quality assessments (EQA) helps laboratories evaluate their performance and guarantee the validity of tests results with the ultimate goal of ensuring high-quality patient care. Here, we describe three benchmarking trials performed during the period 2017–2018 aiming firstly at establishing the state-of-the-art and secondly setting up a NGS-specific EQA program at the national level in the field of clinical (hemato-) oncology in Belgium. DNA samples derived from cell line mixes and artificially mutated cell lines, designed to carry variants of clinical relevance occurring in solid tumors, hematological malignancies, and BRCA1/BRCA2 genes, were sent to Belgian human genetics, anatomic pathology, and clinical biology laboratories, to be processed following routine practices, together with surveys covering technical aspects of the NGS workflows. Despite the wide variety of platforms and workflows currently applied in routine clinical practice, performance was satisfactory, since participating laboratories identified the targeted variants with success rates ranging between 93.06% and 97.63% depending on the benchmark, and few false negative or repeatability issues were identified. However, variant reporting and interpretation varied, underlining the need for further standardization. Our approach showcases the feasibility of developing and implementing EQA for routine clinical practice in the field of (hemato-) oncology, while highlighting the challenges faced.