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Cancer is frequently found in various tissues and organs that are can be problematic to access

such as the ovaries, pancreas and brain among others. Therefore, the detection of biomarkers
within the tissues of such cancers can prove to be difficult and are related to substantial clinical
risk. Patients could bleed or obtain an infection as a result of a traditional invasive biopsy or
excisional surgical procedure.
Surgical biopsies are currently the preferred diagnostic standard for several cancers that
develop solid tumours, but it is not without its shortcomings. One glaring drawback is a tumour
tissue sample only provides a static and spatially limited presentation of the cancer cells at the
time of the surgical biopsy. However, one of the hallmarks of cancer is genome instability and
mutation. Thus, over time tumour evolution commonly occur resulting in a difference in genetic
heterogenicity between the primary and metastatic tumours. Additionally, most of current
biopsies are fix in formalin paraffin embedded (FFPE) as per standard pathology practices. This
decreases their utility for molecular analysis. Some of these shortcomings can be addressed
through liquid biopsies.
A liquid biopsy is a newly emerging non-invasive method of detecting cancer that aims to be
utilised as an alternative to surgical biopsies. The test involves obtaining a blood sample to
observe whether it contains cancerous cells from a tumour circulating in the blood, microRNAs,
exosomes or circulating tumour DNA (ctDNA) with the latter now being lauded as the preferred
detection method. The concept of genetically testing cell-free DNA and free rRNA is not a new
one but has made tremendous strides riding the wave of the potential of liquid biopsies.
Statistics MRC predicts the Global Liquid Biopsy Market will grow from $310 million in 2016 to
over $1.2 billion by 2023.
The advantages of liquid biopsies offer are what make this a hotly contested market.
Theoretically it could be used by Oncologists to aid in the treatment of patients by monitoring
and tracking their response to treatment. They can also observe the tumour growth rate thus
providing doctors with a wealth of information in addition to commonly used imaging techniques.
As doctors are able to take multiple samples over time, ctDNA in the blood can aid physicians in
determining and monitoring the type of mutations in patients’ tumours, formulate and alter
medication guidelines as required.
However, this newly emerging technology is not without some controversy. Researchers from
John Hopkins conducted a study comparing two commercially available liquid biopsy test kits.
The study published in JAMA Oncology, showed that PlasmaSELECT-R64 and Guardant 360
from Personal Genome Diagnostics and Guardant Health diagnostics provided different results
when analysing identical patient samples. Out of the 40 patient samples tested, only 3 had
matching results. Both companies responded to the results of the study criticising the approach
of the original research stating that it was flawed but their responses should be read with
scepticism due to their clear conflict of interest.

Despite this, the liquid biopsy industry continues to grow; a recent study published in the Journal
of Molecular Diagnostics shows that Electric Field-Induced Release and Measurement (EFIRM)
liquid biopsy was successfully able to detect early stage Non-Small-Cell Lung Carcinoma
(NSCLC). Plasma samples in this study were collected prior to surgical biopsies and histologic
examinations. The EFIRM platform performed extremely well with 92% sensitivity and 91%
specificity.
Taken together, liquid biopsy technology is not forecasted to completely replace surgical
biopsies but rather to complement it. It is predicted that this novel technique will be utilised for
early detection, monitoring patients being treated and those in remission. Theoretically, the
technology could detect ctDNA weeks or months before it appears on standard imaging
techniques used to locate solid tumours. Therefore, the next few years are promising for
patients and doctors alike in the ultimate fight against cancer.