Novel blood test detects lung cancer traces long before scans

Despite advances in early-stage lung cancer treatment, a significant number of patients experience disease recurrence after surgery or initial therapy.

A novel study has now demonstrated that a blood test (liquid biopsy) can reliably detect lingering lung cancer traces even in the earliest clinical stages, long before a tumor is large enough to show up on a scan. This real-time genetic monitoring detailed in an article appearing in The Journal of Molecular Diagnostics, AMP's official journal, accurately predicts relapse risk, opening a critical window for timely, personalized therapeutic interventions.

Non–small-cell lung cancer (NSCLC) is the most common type of lung cancer and remains the major cause of cancer-related death. Small tumors in patients with early-stage NSCLC (I to II) are usually surgically removed, and survival rates are reasonably high. However, even in stage I, disease recurrence rates range between 5% and 19%, and imaging follow-up remains standard of care.

“As oncology shifts towards personalized risk-adapted care, liquid biopsies are emerging as a critical tool to bridge the gap between treatment completion and clinical recurrence,” explained lead investigator Matija Snuderl, M.D., of NYU Langone Health and Grossman School of Medicine, and Laura and Isaac Perlmutter Cancer Center.

“In our study, we monitored patients with lung cancer across treatment stages using serial blood draws to track circulating tumor DNA (ctDNA) levels. By analyzing tumor-specific signatures of ctDNA shed by tumor cells into the bloodstream, we evaluated how effectively liquid biopsy predicts relapse compared to standard imaging.”

The most significant finding was that a positive test result for tumor DNA served as a highly sensitive biomarker for minimal residual disease, detecting microscopic recurrence months before scans showed physical tumors, while a clear (negative) test strongly correlated with sustained remission.

“As a surgeon, I follow my patients very closely, and I want to know as soon as possible if the cancer has come back. Unfortunately, even the earliest stage patients risk recurrence,” noted co-lead investigator Harvey I. Pass, M.D., of NYU Langone Health. “Our study’s findings highlight just how sensitive and specific liquid biopsy can be when integrated into routine post-treatment monitoring, even in the earliest stages of lung cancer. This is of critical importance for deciding on post-operative treatments.”

Snuderl added: “Minimal residual disease testing via liquid biopsy represents a fundamental shift in post-operative care. It gives pathologists a powerful tool to diagnose disease before it appears on imaging and equips clinicians with actionable insights to personalize surveillance and intervention strategies for every individual patient."

The study highlights the implications of these blood tests for every stage of the patient journey:

• Clinicians can identify high- or low-risk patients far earlier.

• Test results help guide targeted treatment for patients with detectable residual disease, while potentially sparing those with clear test results from the burden of unnecessary overtreatment and toxicity.

• These liquid biopsies offer actionable clarity, reducing the anxiety of waiting between periodic imaging scans by replacing uncertainty with clear biological data.

• Early detection of relapse allows treatment to restart when the disease burden is extremely low, substantially improving long-term outcomes and survival prognosis.

The WGS liquid biopsy technology used in this study was developed by co-investigator Asaf Zviran, Ph.D., of C2i Genomics Inc. in New York, who concluded, “The true promise of residual disease monitoring has always been to identify patients at high risk of recurrence early enough to enable curative intervention—before the cancer has an opportunity to spread, evolve, and diversify.”

About The Journal of Molecular Diagnostics

The Journal of Molecular Diagnostics, the official publication of the Association for Molecular Pathology, co-owned by the American Society for Investigative Pathology, and published by Elsevier, seeks to publish high-quality original papers on scientific advances in the translation and validation of molecular discoveries in medicine into the clinical diagnostic setting, and the description and application of technological advances in the field of molecular diagnostic medicine.

The editors welcome review articles that contain: novel discoveries or clinicopathologic correlations, including studies in oncology, infectious diseases, inherited diseases, predisposition to disease, or the description of polymorphisms linked to disease states or normal variations; the application of diagnostic methodologies in clinical trials; or the development of new or improved molecular methods for diagnosis or monitoring of disease or disease predisposition.