{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:49:03Z","timestamp":1791622143511,"version":"4.3.4"},"reference-count":35,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Cytopathology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Precision oncology requires diagnostic sampling that delivers molecularly actionable material quickly and safely. In non\u2010small cell lung cancer (NSCLC), core\u2010needle biopsy (CNB) remains common. Yet fine\u2010needle aspiration (FNA) has re\u2010emerged with rapid on\u2010site evaluation (ROSE), optimized cell blocks, and next\u2010generation sequencing. The objective of this study was to compare the economic costs of FNA versus CNB with respect to an\n                      <jats:italic>FNA\u2010first with predefined CNB escalation<\/jats:italic>\n                      strategy for NSCLC clinical pathways.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The authors synthesized evidence on diagnostic adequacy, complication rates, and molecular performance of cytology versus core tissue. A microcosting framework decomposed total diagnostic episode costs into sampling, processing, complications, and remedial procedures. This framework was applied to Sweden\u2019s Standardized Cancer Care Pathway for NSCLC using decision\u2010tree modeling and sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Modern cytology workflows with ROSE achieve a nondiagnostic sampling rate \u22646% and support programmed death\u2010ligand 1 and broad next\u2010generation sequencing with high mutation concordance to surgical specimens. Compared with CNB, FNA incurs fewer major complications and facilitates repeat sampling. In the Swedish illustration, an FNA\u2010first pathway with ROSE reduced expected per\u2010patient diagnostic cost by approximately 33% (7748 vs. 11,637 Swedish krona). The results were robust to \u00b150% variation in complication rates and \u00b15%\u201310% variation in adequacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Reframing\n                      <jats:italic>adequacy<\/jats:italic>\n                      around molecular fitness and time to actionability supports FNA where ROSE exists, with codified, same\u2010episode CNB escalation. This approach advances safety, capacity, and timeliness without compromising molecular yield. The authors provide a transferable cost\u2010consequence model and implementation checklist for health systems. Local recalibration is required for absolute cost values, and multisite calibration is encouraged to establish generalizability across the different settings.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncy.70152","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T13:34:34Z","timestamp":1788874474000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Economic value and clinical role of minimally invasive, biopsy\u2010based diagnostics in non\u2010small cell lung cancer"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1835-3176","authenticated-orcid":false,"given":"Jiayuan","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Neurobiology, Care Sciences, and Society Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1234-4981","authenticated-orcid":false,"given":"Bo","family":"Franz\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Oncology\u2013Pathology Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9941-9172","authenticated-orcid":false,"given":"Rolf","family":"Lewensohn","sequence":"additional","affiliation":[{"name":"Department of Oncology\u2013Pathology Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6544-5399","authenticated-orcid":false,"given":"Martin","family":"Hysek","sequence":"additional","affiliation":[{"name":"Department of Oncology\u2013Pathology Karolinska Institute  Stockholm Sweden"},{"name":"Department of Pathology and Cancer Diagnostics Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linus","family":"J\u00f6nsson","sequence":"additional","affiliation":[{"name":"Department of Neurobiology, Care Sciences, and Society Karolinska Institute  Stockholm 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