Chapter 8: Liquid Biopsy: Circulating Tumor DNA (ctDNA) & Minimal Residual Disease
Chapter 8: Liquid Biopsy: Circulating Tumor DNA (ctDNA) & Minimal Residual Disease
Standard solid tissue needle biopsies are invasive, carry procedural risks, and fail to capture intratumoral spatial heterogeneity. Liquid biopsy analyzes circulating tumor DNA (ctDNA) shed by apoptotic and necrotic cancer cells into peripheral blood, enabling non-invasive tumor profiling, therapy response monitoring, and early recurrence detection.
Circulating cell-free DNA (cfDNA) is degraded by plasma endonucleases into nucleosomal fragments displaying a characteristic size peak at 167 bp (corresponding to DNA wrapped around a histone octamer plus linker DNA). ctDNA fragments are often slightly shorter (~140–150 bp) than healthy leukocyte cfDNA.
1. Overcoming the Noise Floor with Duplex UMIs
Standard Illumina sequencers have a baseline error rate of ~0.1–1% (1 in 1,000 bases). Detecting rare ctDNA mutations at Variant Allele Frequency (VAF) of 0.05% requires Duplex Molecular Inversion Probes (MIPs) or Duplex UMIs that independently tag both the top and bottom strands of original double-stranded DNA molecules. A true somatic mutation appears on both complementary strands; sequencing/PCR errors appear on only one strand and are discarded.
2. Minimal Residual Disease (MRD) Surveillance
Following surgical resection of a primary tumor, patients with detectable ctDNA in serial plasma draws have a >10-fold higher risk of clinical relapse. Post-surgical ctDNA clearance serves as a sensitive molecular endpoint for adjuvant chemotherapy trials.