The current highly dynamic business environment requires businesses to be agile. Business agility is the ability to swiftly and easily change businesses and business processes beyond the normal level of flexibility to effectively manage unpredictable external and internal changes. This study reports on a crossindustry analysis of change factors requiring agility and assesses agility gaps that companies are facing in four industry sectors in the Netherlands. A framework was constructed to measure the perceived gaps between the current level of business agility and the required level of business agility. The questionnaire and in-depth interviews held reveal that today's businesses perceive to lack the agility required to quickly respond to changes, whose speed and requirements are difficult to predict. The paper presents rankings of generic and sector-specific agility gaps. These show that although some generic change factors requiring agility exist, the change factors requiring agility that cause agility gaps differ across industry sectors. Among the factors that enable or hinder business agility, the existence of inflexible legacy systems is perceived to be a very important disabler in achieving more business agility. A number of basic principles and directions are discussed to transform Information Technology from barrier into key enabler for increased agility in organizations and business networks.

For treatment purposes, distinction between squamous cell carcinoma and adenocarcinoma is important. The aim of this study is to examine the diagnostic accuracy on lung cancer small biopsies for the distinction between adenocarcinoma and squamous cell carcinoma and relate these to immunohistochemical and KRAS and EGFR mutation analysis. An interobserver study was performed on 110 prospectively collected biopsies obtained by bronchoscopy or transthoracic needle biopsy of patients with non-small cell lung cancer. The diagnosis was correlated with immunohistochemical (IHC) analysis for markers of adeno- (TTF1 and/or mucin positivity) and squamous cell differentiation (P63 and CK5/6) as well as KRAS and EGFR mutation analysis. Eleven observers independently read H&E-stained slides of 110 cases, resulting in a kappa value of 0.55 ± 0.10. The diagnosis non-small cell lung cancer not otherwise specified was given on average on 29.5 % of the biopsies. A high concordance was observed between hematoxylin-eosin-based consensus diagnosis (≥8/11 readings concordant) and IHC markers. In all cases with EGFR (n = 1) and KRAS (n = 20) mutations, adenodifferentiation as determined by IHC was present and p63 staining was absent. In 2 of 25 cases with a consensus diagnosis of squamous cell carcinoma, additional stainings favored adenodifferentation, and a KRAS mutation was present. P63 is most useful for distinction between EGFR/KRAS mutation positive and negative patients. In the diagnostic work-up of non-small cell lung carcinoma the limited reproducibility on small biopsies is optimized with immunohistochemical analysis, resulting in reliable delineation for predictive analysis.

The diagnostic landscape of non-small cell lung cancer (NSCLC) is changing rapidly with the availability of novel treatments. Despite high-level healthcare in the Netherlands, not all patients with NSCLC are tested with the currently relevant predictive tumor markers that are necessary for optimal decision-making for today's available targeted or immunotherapy. An expert workshop on the molecular diagnosis of NSCLC involving pulmonary oncologists, clinical chemists, pathologists, and clinical scientists in molecular pathology was held in the Netherlands on December 10, 2018. The aims of the workshop were to facilitate cross-disciplinary discussions regarding standards of practice, and address recent developments and associated challenges that impact future practice. This paper presents a summary of the discussions and consensus opinions of the workshop participants on the initial challenges of harmonization of the detection and clinical use of predictive markers of NSCLC. A key theme identified was the need for broader and active participation of all stakeholders involved in molecular diagnostic services for NSCLC, including healthcare professionals across all disciplines, the hospitals and clinics involved in service delivery, healthcare insurers, and industry groups involved in diagnostic and treatment innovations. Such collaboration is essential to integrate different technologies into molecular diagnostics practice, to increase nationwide patient access to novel technologies, and to ensure consensus-preferred biomarkers are tested.

This study reports on a cross-industry analysis o f t h e current drivers for agilio, and agiliy gaps. which con~panies a r ~f a c i n g infour industn sectorsIn the Netherlalds. A fi-ame~i'ork was constrz~cted to n1easur.e the gaps between the current level ofbusiness agility and the required level ofbusiness agility. The qzrestionnnn.e and in-depth interviews reveal that todaj~ 's businesses lack the ng&); required to qlticlrly respond to largely unanticipclted cliaiiges. The paperpresents ranlrings ofgeneric and sector-speci$c agd@ gaps. These show that although some generic drivers exist, key drivers are vety different aowss ind~rstry sectors.

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