Medical Disclaimer
genoCDS is a clinical reference tool for qualified healthcare professionals only. Content is derived from published guidelines and regulatory sources and may contain errors or outdated information. It is not a substitute for professional medical judgment, institutional protocols, or individual patient assessment. Always verify recommendations against current primary sources before making clinical decisions. Full disclaimer →
Stage Stage IIIA
Ipsilateral mediastinal or subcarinal nodal involvement, or T3-4/N1-2/M0. Potentially resectable in select cases; often requires multidisciplinary evaluation.
3 test recommendations across 1 clinical indication
Stage IIIA (T1-T2, N1, M0) colon cancer. MSI-H/dMMR identifies Lynch syndrome candidates; BRAF V600E aids interpretation.
Required — 1 test
Microsatellite Instability / Mismatch Repair Status (MSI/MMR)
MSI/MMR
Testing for microsatellite instability (MSI) and/or mismatch repair (MMR) deficiency. Methods: PCR-based MSI testing, IHC for MMR proteins (MLH1, MSH2, MSH6, PMS2), or NGS-based MSI calculation. MSI-H (high instability) / dMMR (deficient MMR) is an FDA-approved pan-tumor biomarker for pembrolizumab and dostarlimab. MSI-H/dMMR is rare in NSCLC (<1%) but justifies routine testing given pan-tumor approval. IHC for MMR proteins can be performed on most tissue specimens.
Ordering Note
Required for all Stage III CRC (NCCN Cat. 1). MSI-H informs adjuvant chemotherapy choices and Lynch syndrome assessment.
Specimen
Evidence
Recommended — 1 test
BRAF V600E Mutation Analysis
BRAF V600E
Detection of BRAF V600E (p.Val600Glu) point mutation. Dabrafenib + trametinib (Tafinlar + Mekinist) is FDA-approved for BRAF V600E-mutant metastatic NSCLC. BRAF V600E occurs in 1.5–4% of NSCLC, more commonly in adenocarcinoma, and is enriched in current/former smokers. Non-V600E BRAF mutations occur more frequently but currently lack approved targeted therapy.
Ordering Note
Recommended alongside MSI testing. BRAF V600E in MSI-H context distinguishes sporadic from Lynch syndrome. In MSS tumors, strong negative prognostic marker.
Specimen
Evidence
Optional — 1 test
Comprehensive Solid Tumor NGS Panel
Comprehensive NGS
Next-generation sequencing panel covering ≥300 cancer-relevant genes, including all major NSCLC drivers (EGFR, ALK, ROS1, BRAF, KRAS, MET, RET, NTRK, HER2, FGFR), plus tumor mutational burden (TMB) and microsatellite instability (MSI). Examples include FoundationOne CDx, Tempus xT, Caris MI Transcriptome, and equivalent institutional panels. Preferred over single-gene sequential testing for efficiency and cost-effectiveness.
Ordering Note
Consider to identify actionable alterations (KRAS G12C, HER2, NTRK) that may become relevant at recurrence.
Specimen
Evidence
Payer Coverage
Payer Coverage Summary
Coverage status as of last policy review. Prior authorization requirements and coverage criteria may change. Verify directly with each payer before ordering.
| Test | Medicare (CMS) | UnitedHealth | Anthem BCBS | Humana | Cigna | Aetna |
|---|---|---|---|---|---|---|
| MSI/MMR | Covered | Covered | Unknown | Unknown | Unknown | Unknown |
| Comprehensive NGS | Covered | Covered | Covered | Prior Auth | Covered | Covered |
Coverage data last verified via automated policy research. Always confirm current policies with each payer.
Recommendations on this page are derived from publicly available guidelines (NCCN, ASCO, ESMO, FDA, OncoKB) and are paraphrased for reference. They do not constitute medical advice. Evidence levels reflect the grading systems of each respective organization and should be interpreted in clinical context. This reference is updated periodically but may not reflect the most recent guideline revisions.