I used chicken broth instead of the water; organic condensed cream of mushroom soup instead of the cream of chicken soup and I added a couple of tablespoons of organic powdered chicken boullion (along with a bit of sage and thyme, since I used mushroom soup, instead of chicken). Next time, I will add a couple of cloves of garlic, too. Oh, and 1/4 cup of cheddar cheese was not nearly enough to cover a 9" x 13" dish -- I doubled that. I agree that spaghetti, as another reviewer mentioned, is not the best choice for holding the sauce, but Tetrazzini is supposed to be spaghetti, so you'd have to change the name, I would think, if you used a different pasta.
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I used chicken broth instead of the water; organic condensed cream of mushroom soup instead of...