A physician-led library on molecular (NGS) cancer reports: from a patient's first look at the page to the disciplined reasoning behind a structured second opinion.
The plain-language entry point. What an NGS report is saying, and what a specific result means for you, written for patients and families.
A guided walk through the five parts of a 15–30 page report that matter most, and the questions to bring to your oncologist.
What a single result means on your report, gene by gene. Actionability is tumor-type and treatment-line dependent; these pages show why.
For clinicians. The hub page maps a comprehensive genomic profiling report; the spokes explain each component that has to be interpreted before it drives a decision.
Past the highlighted "actionable" findings: clonality, evidence tier, co-alterations and the limits of the assay, read in the patient's context.
What variant allele frequency does and doesn't tell you: clonal vs subclonal, purity effects, and where the number misleads.
Why a low-purity sample suppresses VAF and can under-call real alterations, and how to read around it.
Inherited or acquired? A distinction that matters for the patient and the family, and one tumor-only panels can blur.
Variant pathogenicity is not the same as actionability. What the classification means, and why a VUS is not discarded.
What tumor mutational burden counts, the ≥10 mut/Mb threshold, and why it is a gradient rather than a switch.
Microsatellite instability and mismatch-repair deficiency: an immunotherapy signal and a Lynch-syndrome clue.
Homologous recombination deficiency, genomic scars, and what they imply for PARP and platinum sensitivity.
Loss of heterozygosity: the second hit, a component of HRD scars, and its role at the HLA locus.
The honest middle category: a biomarker with no matched therapy is a finding to monitor, not a treatment to chase.
Reading tumor DNA from blood: shedding, VAF, plasma-first logic, and reconciling liquid with tissue.
The framework that turns a report into a strategy: the same logic applied to every case, and how it's assembled into the deliverable you receive.
The seven questions between an alteration and a defensible action, and the predictable points where the chain breaks.
The step-by-step framework applied to the hard cases: a driver with no matched drug, conflicting assays, a borderline VAF.
How the report is organized: orientation, evidence, decision, advisory, and the calibration layer that shows how solid each conclusion is.
The deep end: grading evidence honestly, and evaluating off-label opportunities with discipline rather than optimism.
Study design, maturity, endpoint quality, effect size, and the single most consequential question: is the evidence tumor-matched?
Off-label is not a free pass. The questions an option must survive before it's even presented, and what we will not do.
Patient explainers and clinician notes in a single feed: the academy's ideas in practice. Filter by topic or search the titles.
New reading room pieces (variant interpretation, resistance mapping and the literature behind a molecular second opinion) are being written. One note a month, physician to physician.
Start with this month’s long readNGS Advisory reviews your existing NGS report against current guidelines, checks for gaps such as untested RNA fusions, and returns a structured, calibrated second opinion.
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