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Updated: Jun 20, 2026
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Detection and Monitoring of Tumor Associated Circulating DNA in Patient Biofluids
Published on: June 8, 2019
Circulating Tumor DNA Testing in Solid Tumors and Lymphoma: ASCO Guideline
Christina M Lockwood1, Hans J Messersmith2, Annette S Kim3
1University of Washington School of Medicine, Seattle, WA.
JCO Oncology Practice
|June 18, 2026
Summary
Circulating tumor DNA (ctDNA) testing can guide cancer treatment when tissue biopsy is difficult or risky. Negative ctDNA results require tissue confirmation, and fractional ctDNA measures are not recommended.
Area of Science:
- Oncology
- Molecular Diagnostics
- Genetics
Background:
- ASCO guidelines offer evidence-based recommendations for clinical practice.
- Circulating tumor DNA (ctDNA) testing is an emerging tool in cancer management.
- Patient representation is included in guideline development.
Purpose of the Study:
- To provide guidance on the clinical utility of ctDNA testing in patients with solid tumors or lymphoma.
- To establish recommendations for ctDNA testing in oncology.
Main Methods:
- Systematic literature review from January 2017 to February 2025.
- Multidisciplinary panel with patient representation.
- Analysis of meta-analyses, study reports, and randomized trials.
Main Results:
- Fifty-four meta-analyses and 22 study reports were reviewed.
- Seven randomized trials were included in the evidence base.
- Identified specific scenarios for ctDNA testing utility.
Conclusions:
- ctDNA testing is recommended when tumor tissue testing is challenging, infeasible, risky, or delayed.
- Tissue confirmation is advised for negative, inconclusive, or inconsistent ctDNA results.
- Fractional ctDNA measures are not recommended as surrogates for disease monitoring.
