BACKGROUND AND OBJECTIVES: Molecular genetic testing using tissue biopsies can be challenging for patients due to unfavorable tumor sites, the invasive nature of a tissue biopsy, and the added time of booking a repeat biopsy (re-biopsy). Centers in Canada have found insufficient tissue rates to be approximately 10%, and even among successful biopsies, insufficient DNA in tissue samples is approximately 16%, triggering the lengthy process of re-biopsies. Using aNSCLC as an example, this study sought to characterize the health and budget impact of alternative liquid-biopsy(LBx)-based comprehensive genomic profile (CGP) testing in tissue-limited patients (TL-LBx-CGP) from a Canadian publicly funded healthcare perspective. MATERIAL AND METHODS: An economic model was developed to estimate the incremental cost and life-years gained as a population associated with adopting TL-LBx-CGP. The eligible patient population was modeled using a top-down epidemiological approach based on the published literature and expert clinician input. Treatment allocation was modeled based on biomarker prevalence in the published literature, and the availability of funded therapies. Costs included molecular testing, as well as drug, administrative, and supportive costs, and relevant health data included median overall survival and median progression-free survival data. RESULTS: Incorporation of TL-LBx-CGP demonstrated an overall impact of $14.7 million with 168 life-years gained to the Canadian publicly funded healthcare system in the 3-year time horizon.

Peritoneal tuberculosis resembles ovarian cancer clinically, and radiologic and laboratory findings present similarities. It was mistaken for ovarian cancer in 1 of the 4 cases reported on. All patients were HIV-negative multiparas between 35 and 42 years of age with adnexal masses and exudative ascites. Laboratory studies did not isolate mycobacteria or detect malignant cells from ascitic fluid. Ascitic adenosinedeaminase (ADA) levels were raised in 3 patients and serum cancer antigen (CA)-125 was raised in 2; the results of chest radiographs were normal in 3; no patient had menstrual symptoms; and all recovered with antitubercular therapy.Patient 1 presented in 2002 with fever, adnexal masses, ascites, a serum CA-125 level of 283 IU/ mL (normal b 35 IU/mL), and negative Mantoux tuberculin skin test results. Her husband had tuberculosis previously. Ultrasonographic and computed tomographic examinations revealed an echogenic right ovarian mass of 5 cm, omental masses, and retroperitoneal lymphadenopathy. Laparoscopy, then laparotomy (because of adhesions) showed 1-cm nodules on the peritoneum, omentum, and adnexa that were found tubercular on histologic evaluation.Patient 2 presented in 2004 with weight loss, adnexal masses, an ascitic ADA level of 98 IU/L (normal b 32 IU/L), and negative Mantoux test results. Ultrasonographic and computed tomographic examinations revealed solid cystic bilateral adnexal masses 5 cm in diameter, omental masses, and para-aortic lymphadenopathy. On laparoscopic examination she had tubo-ovarian masses and 2-cm nodules on the peritoneum, omentum, uterus, and liver that were found tubercular on histologic evaluation.Patient 3 presented in 2004 with weight loss, a left adnexal mass, posterior fornix nodularity, and an ascitic ADA level of 72 IU/L. She underwent laparotomy for suspected ovarian malignancy. She

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