Comprehensive Genomic Profiling for Precision Oncology: Analytical Validation and Clinical Utility in Solid Tumors

Background: Comprehensive genomic profiling (CGP) is increasingly used in precision oncology to identify actionable genomic alterations and guide targeted therapies in solid tumors. However, the clinical implementation of CGP assays requires rigorous analytical validation to ensure accurate and reproducible detection of diverse genomic alterations across heterogeneous tumor samples. Despite rapid advancements in next-generation sequencing technologies, there remains a need for validated CGP platforms that demonstrate reliable performance and readiness for routine clinical use. Methods: This study evaluated the analytical and clinical performance of a CGP assay capable of detecting multiple genomic alteration types, including single nucleotide variants (SNVs), insertions/deletions (Indels), copy number variations (CNVs), gene fusions, and tumor mutational burden (TMB). Validation was conducted using patient-derived 117 FFPE tumor samples, external proficiency testing materials, and reference standards. Assay performance was assessed through comparison with orthogonal methods and through evaluation of reproducibility, limit of detection, and TMB concordance. Results: The assay demonstrated excellent analytical performance, achieving 100% sensitivity, specificity, and accuracy for variant detection across evaluated samples. Strong concordance was observed for TMB estimation (R² = 0.9925), with consistent classification of TMB-high cases. The assay showed robust inter- and intra-run reproducibility and reliable detection of low-frequency variants. Limit-of-detection (LOD) analysis confirmed accurate SNV detection at approximately 1% variant allele frequency and reliable RNA fusion detection at low input levels. Conclusions: The validated CGP assay provides accurate, reproducible, and comprehensive detection of clinically relevant genomic alterations in solid tumors. These results support its suitability for routine clinical deployment, enabling reliable genomic profiling to inform precision oncology treatment decisions.