{ "metadata": { "name": "MR. MANGAL PRASAD", "cr_no": "EXT129693", "age_sex": "43Y/Male", "referred_doctor": "Dr. ANSHUL GUPTA(Apollo) Hospital", "sample_type": "Tumor Tissue (FFPE block) –B/9248/26 (Outside Block)", "diagnosis": "Metstatic Lung adenocarcinoma", "tumor_fraction": "~20%", "order_no": "", "order_date": "31.07.2026", "receiving_date": "01.08.2026", "reporting_date": "26.08.2026", "lab_id": "2026215-2266" }, "report_information": { "panel_title": "NGS SMART Lung Panel" }, "clinical_content": { "sections": [ { "heading": "Report Highlights", "order": 1, "content": "Alteration detected", "page": 1, "source_lines": [ 59 ], "children": [ { "kind": "list_item", "content": "EML4 - ALK Variant 1 (Gene Rearrangement)", "page": 1, "order": 2 }, { "heading": "RNA Sequence Variants", "order": 3, "page": 1, "source_lines": [ 82 ], "children": [ { "kind": "table", "headers": [ "Total mapped", "Read counts per" ], "rows": [ [ "Gene Locus Variant ID", "" ], [ "reads", "million" ], [ "EML4(13) - ALK(20) chr2:42522656 - chr2:29446394 EML4-ALK.E13A20.COSF408.1 16957", "81331.26772" ] ], "order": 4 }, { "heading": "Genomic Assembly", "order": 5, "content": "GrCH 37(hg19)", "page": 1, "source_lines": [ 63 ] } ] }, { "heading": "Interpretation Summary", "order": 6, "content": "EML4::ALK Variant 1 is an oncogenic driver in NSCLC, resulting in constitutive ALK kinase activation (PMID:21030459, 22277784).\nIt supports ALK-rearranged NSCLC and predicts sensitivity to ALK-targeted TKIs. In comparative studies, Variant 1 has been\nassociated with a more favorable clinical course and longer progression-free survival than Variant 3.", "page": 1, "source_lines": [ 65, 66, 67, 68 ] }, { "heading": "Clinical Significance", "order": 7, "page": 1, "source_lines": [ 52 ], "children": [ { "heading": "Variant:EML4 - ALK Variant 1", "order": 8, "page": 1, "source_lines": [ 71 ], "children": [ { "heading": "Pathogenic Contribution", "order": 9, "content": "The EML4(13) - ALK(20)(Variant 1)fusion involves the N-terminus of EML4 combined with the C-terminus of ALK,\nincluding the ALK tyrosine kinase domain. This mutation has been found in non-small cell lung cancer (PMID:22277784).\nExpression of the EML-ALK fusion in non-small cell lung cancer and hematopoietic cells demonstrated that it is activating\nas measured by increased protein and pathway activation (PMID: 21030459, 21613408, 21613408, 21791641,\n21948233, 22235099, 22277784, 24675041, 25228534).", "page": 1, "source_lines": [ 72, 73, 74, 75, 76, 77 ] }, { "heading": "Predictive/Therapeutic Significance", "order": 10, "content": "The ALK-targeted inhibitors Crizotinib, Ceritinib, Alectinib, Brigatinib, Lorlatinib and Ensartinib are FDA-approved for the", "page": 1, "source_lines": [ 79, 80 ] }, { "heading": "Prognostic Significance", "order": 11, "content": "EML4-ALK Variant 1 (V1) is a longer ALK fusion variant that retains an incomplete TAPE (tandem atypical propeller in\nEML) domain, resulting in comparatively lower stability of the fusion oncoprotein than shorter variants such as Variant 3\n(V3). In large cohorts of ALK-positive non-small cell lung cancer (NSCLC), V1 has been consistently associated with a\nmore favorable prognosis relative to V3. In a cohort of 634 ALK-positive lung cancers, V1 showed a significantly lower\nenrichment of secondary ALK resistance mutations compared with V3 (P < 0.0002), supporting a more indolent\nmolecular behavior (Ou Si H et al;doi:10.1200/JCO.2017.35.15_suppl.9010). Clinically, multiple studies have\ndemonstrated that patients harboring V1 experience longer progression-free survival and delayed disease progression\non next-generation ALK tyrosine kinase inhibitors (TKIs), including alectinib, brigatinib, and lorlatinib, when compared", "page": 2, "source_lines": [ 149, 150, 151, 152, 153, 154, 155, 156, 157 ] }, { "heading": "Diagnostic Significance", "order": 12, "page": 2, "source_lines": [ 160 ], "children": [ { "heading": "Additional Note", "order": 13, "content": "Report highlights were conveyed to Dr. Anshul Gupta on 26/08/2026, 02:30 pm.", "page": 2, "source_lines": [ 164 ] } ] } ] } ] }, { "heading": "Assay Information and Methodology", "order": 14, "content": "The assay utilizing a minimum of 10ng of DNA and 10ng of RNA at 500X coverage provides an analytical sensitivity of more than equal to 5\npercent for DNA-based genetic alteration.\nVariants of strong and potential clinical significance are only reported in somatic panels.", "page": 2, "source_lines": [ 166, 197, 198, 201 ], "children": [ { "heading": "Test Description", "order": 15, "content": "– This customized panel is a multi-biomarker next generation sequencing assay that interrogates the under mentioned genes for\nSingle nucleotide Variants (SNVs) and Fusion Rearrangements as mentioned below.", "page": 2, "source_lines": [ 169, 170 ] }, { "heading": "Genes Analyzed for SNVs", "order": 16, "content": "AKT1, ALK, BRAF, EGFR, ERBB2, KRAS, KEAP1, MET, NRAS, NTRK1, PTEN, RB1, ROS1, TP53, STK11,SMARCA4", "page": 2, "source_lines": [ 173 ] }, { "heading": "Genes Analyzed for Rearrangements", "order": 17, "content": "ABL1, AKT3, ALK, AXL, BRAF, EGFR, ERBB2, ERG, ETV1, ETV4, ETV5, FGFR1, FGFR2, FGFR3, MET, NTRK1, NTRK2,\nNTRK3, PDGFRA, PPARG, RAF1, RET, ROS1, SMO.", "page": 2, "source_lines": [ 176, 177 ] }, { "heading": "Quality Metrics", "order": 18, "metrics": { "DNA": { "status": "PASSED", "Mean depth of coverage": "2257x", "Uniformity": "94.38%" }, "RNA": { "status": "PASSED", "Total mapped fusion reads": "2,08,493 (Cutoff for QC Pass >20,000)" } }, "page": 2, "source_lines": [ 180, 183, 186, 188, 191, 194 ] }, { "heading": "Disclaimer", "order": 19, "content": "The information in this report does not constitute a treatment recommendation or recommendation to not use any specific therapeutic agent,\nand it should not be interpreted as treatment advice. Decisions concerning patient care and treatment rest solely within the discretion of the patient's\ntreating physician.", "page": 3, "source_lines": [ 256, 257, 258 ] } ] } ] } ] }, "authorization": { "performed_by": "Mamta Arya Scientist C\nAkaash Kumar Scientist B\nMolecular Diagnostics", "reviewed_by": "Dr Rushali Saxena\nAttending Consultant, Pathology", "approved_by": "Dr. Anurag Mehta\nPrincipal Director Laboratory Services\nRajiv Gandhi Cancer Institute & Research Centre.\nRohini, New Delhi." }, "processing": { "source_file": "/app/uploads/29382_EGFR RT PCR, LUNG NGS PANEL, ALK BY IHC (SMART LUNG PANEL).pdf", "content_hash": "945c598bc18128f43d3204c9873fb19541a27f13dacc190dd374989f9b1ae255", "processed_at": "2026-09-12T07:20:27.236814+00:00", "pipeline_version": "1.0.0", "pipeline_name": "molecular", "pages": 3, "sections_detected": 1, "warnings_count": 0, "skipped_image_blocks": 3, "skipped_figure_lines": 0, "content_coverage": 0.9913, "validation_status": "PASSED", "validation_failures": [], "validation_warnings": [], "header_layout": "B" } }