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Background <p>Breast cancer distant recurrence remains a fear for patients. Circulating tumor DNA (ctDNA) has been identified as a possible marker for recurrence using tissue-informed assays. This study sought to describe the differences in patient characteristics between those with detectable ctDNA (+ctDNA) and those with undetectable ctDNA (−ctDNA), as well as the management of +ctDNA patients.</p> Methods <p>A retrospective chart review included 227 female patients who had undergone surgery for stages I to III breast cancer and elected to undergo Signatera ctDNA-testing at 6-month intervals from January 2022 to May 2025. A comparative analysis between +ctDNA and −ctDNA patients was performed with Fisher’s exact test and unpaired <i>t</i> test. A qualitative analysis was used for the +ctDNA patients.</p> Results <p>Of the 227 patients, 10 (4.41%) were found to have +ctDNA. The +ctDNA patients had an advanced pathologic stage (<i>p</i> = 0.015) with nodal involvement (<i>p</i> = 0.037). All the +ctDNA patients underwent PET imaging. Of the 10 patients, 7 had metastases and were given systemic therapy. For the remaining three patients, initial metastatic imaging was negative. One of these patients had a repeat ctDNA 6 months later and was found to have an increase in the value. Repeat imaging was obtained and demonstrated metastasis. The second patient opted to be monitored clinically and continue endocrine therapy. The last patient with negative imaging underwent repeat ctDNA testing which was found to be negative and questionable for an initial false-positive result.</p> Conclusions <p>In the surveillance of high-risk patients (advanced TNM staging), ctDNA may be valuable.</p>

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Recurrence in Real Time: Rethinking Breast Cancer Follow-Up Evaluation with Circulating Tumor DNA

  • 期刊论文

  • 发表日期：

    2026年8月3日

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  • Nicole Taylor,
  • York Lin Chew,
  • Tian Sheng Ng,
  • J. Alexander Palesty,
  • Beth Sieling,
  • Nicole Sookhan

摘要

Background

Breast cancer distant recurrence remains a fear for patients. Circulating tumor DNA (ctDNA) has been identified as a possible marker for recurrence using tissue-informed assays. This study sought to describe the differences in patient characteristics between those with detectable ctDNA (+ctDNA) and those with undetectable ctDNA (−ctDNA), as well as the management of +ctDNA patients.

Methods

A retrospective chart review included 227 female patients who had undergone surgery for stages I to III breast cancer and elected to undergo Signatera ctDNA-testing at 6-month intervals from January 2022 to May 2025. A comparative analysis between +ctDNA and −ctDNA patients was performed with Fisher’s exact test and unpaired t test. A qualitative analysis was used for the +ctDNA patients.

Results

Of the 227 patients, 10 (4.41%) were found to have +ctDNA. The +ctDNA patients had an advanced pathologic stage (p = 0.015) with nodal involvement (p = 0.037). All the +ctDNA patients underwent PET imaging. Of the 10 patients, 7 had metastases and were given systemic therapy. For the remaining three patients, initial metastatic imaging was negative. One of these patients had a repeat ctDNA 6 months later and was found to have an increase in the value. Repeat imaging was obtained and demonstrated metastasis. The second patient opted to be monitored clinically and continue endocrine therapy. The last patient with negative imaging underwent repeat ctDNA testing which was found to be negative and questionable for an initial false-positive result.

Conclusions

In the surveillance of high-risk patients (advanced TNM staging), ctDNA may be valuable.