Concordance of Genomic Alterations by Next-Generation Sequencing in Tumor Tissue versus Circulating Tumor DNA in Breast Cancer

• Published in: Molecular cancer therapeutics 2017-07, Vol.16 (7), p.1412-1420
• Main Authors: Chae, Young Kwang, Davis, Andrew A, Jain, Sarika, Santa-Maria, Cesar, Flaum, Lisa, Beaubier, Nike, Platanias, Leonidas C, Gradishar, William, Giles, Francis J, Cristofanilli, Massimo
• Format: Article
• Language: English
• Subjects: Biomarkers, Tumor - genetics; Biopsy; BRCA1 protein; BRCA1 Protein - genetics; BRCA2 protein; BRCA2 Protein - genetics; Breast cancer; Breast Neoplasms - blood; Breast Neoplasms - genetics; Breast Neoplasms - pathology; Cancer; Cell Line, Tumor; Circulating Tumor DNA - blood; Circulating Tumor DNA - genetics; Class I Phosphatidylinositol 3-Kinases - genetics; Contamination; Deoxyribonucleic acid; DNA; DNA fingerprinting; DNA sequencing; ErbB-2 protein; Female; Gene frequency; Genes; Genome, Human; Genomics; High-Throughput Nucleotide Sequencing; Humans; Male; Middle Aged; Mutation; p53 Protein; Peripheral blood; Receptor, ErbB-2 - genetics; Tumor Suppressor Protein p53 - genetics
• ISSN: 1535-7163; 1538-8514
• DOI: 10.1158/1535-7163.mct-17-0061

While identifying genomic alterations in tumor tissue is the current gold-standard technique for molecular profiling, circulating tumor DNA (ctDNA) represents a noninvasive method of assessing genomic alterations using peripheral blood. The concordance of genomic alterations between two commercially available ctDNA and tissue biopsies was compared in 45 patients with breast cancer using paired next-generation sequencing tissue and ctDNA biopsies. Across all genes, concordance between the two platforms was 91.0% to 94.2%. When only considering genomic alterations in either assay (e.g., excluding wild type/wild type genes), concordance was 10.8% to 15.1% with full plus partial concordance of 13.8% to 19.3%. Concordant mutations were associated with significantly higher variant allele frequency. Over half of mutations detected in either technique were not detected using the other biopsy technique. Including variants of unknown significance, the average number of alterations per patient was significantly higher for tissue (4.56) compared with ctDNA (2.16). When eliminating alterations not detectable in the ctDNA assay, mean number of alterations for tissue and ctDNA was similar (2.67 for tissue, 2.16 for ctDNA). Across five representative genes ( , and ), sensitivity and specificity were 35.7% and 95.0%, respectively. Concordance when genomic alterations was detected in either tissue or ctDNA was low with each technique detecting a significant amount of nonoverlapping mutations. Potential explanations for the lack of concordance include tumor heterogeneity, different sequencing techniques, spatial and temporal factors, and potential germline DNA contamination. The study indicates that both tissue and blood-based NGS may be necessary to describe the complex biology of breast cancer. .