At present, when ROS1 testing is required, it will be reasonable to test the same tumours currently being selected for EGFR mutation and ALK gene rearrangement. Although this should ideally occur in parallel, this is not possible in all cases. Therefore, in order to save tissue and time, it is wise to cut extra blank sections at the first cutting session [60]. FISH remains the core test for the time being. Laboratories may use IHC as a screening tool, but with our current state of knowledge, a positive IHC test should be confirmed by FISH testing. If laboratories chose to use a multiplex PCR approach instead of FISH, they should be aware of the possible pitfalls of this highly sensitive and specific technique, in terms of sample quality and risks of test failure.
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