Feasibility of EGFR Mutation Testing Without Nucleic Acid Extraction in Scraped Cytologic Samples Using the Idylla Platform

This study aimed to evaluate the feasibility of performing EGFR mutation testing on cytologic material without prior nucleic acid extraction using the fully automated Idylla platform. This simplified approach may facilitate broader access to molecular testing in pathology departments lacking dedicated molecular facilities and reduce turnaround times when cytology represents the only available material. A total of 30 scraped cytology preparations from 20 patients (9 EGFR-mutated and 11 wild-type) were analyzed. Slides were destained, scraped, and the recovered material was transferred onto the Idylla cartridge filter paper pre-moistened with nuclease-free water. Results were compared with those obtained using a reference molecular method performed on the corresponding paraffin-embedded cell block from the same specimen. Three runs (10%) were invalid, all from the same pleural fluid specimen harboring an exon 19 deletion, suggesting DNA degradation. Three cases (11.11%) with low absolute tumor cellularity (below the 20th percentile of the cohort) yielded false-negative results, despite a tumor percentage greater than 10%. No false-positive or misclassified variants were detected. These findings indicate that EGFR mutation testing can be accurately performed on scraped cytologic material using the Idylla platform without prior nucleic acid extraction, with caution advised for specimens with low absolute tumor cellularity. The proposed workflow is technically feasible in any pathology laboratory, potentially enabling shorter turnaround times, and broader access to EGFR testing in routine clinical practice.