Circulating tumor DNA (ctDNA) sequencing is being rapidly adopted in precision oncology, but the accuracy, sensitivity and reproducibility of ctDNA assays is poorly understood. Here we report the findings of a multi-site, cross-platform evaluation of the analytical performance of five industry-leading ctDNA assays. We evaluated each stage of the ctDNA sequencing workflow with simulations, synthetic DNA spike-in experiments and proficiency testing on standardized, cell-line-derived reference samples. Above 0.5% variant allele frequency, ctDNA mutations were detected with high sensitivity, precision and reproducibility by all five assays, whereas, below this limit, detection became unreliable and varied widely between assays, especially when input material was limited. Missed mutations (false negatives) were more common than erroneous candidates (false positives), indicating that the reliable sampling of rare ctDNA fragments is the key challenge for ctDNA assays. This comprehensive evaluation of the analytical performance of ctDNA assays serves to inform best practice guidelines and provides a resource for precision oncology.
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Descriptive data about individual ctDNA assays are provided in Supplementary Data 2. Descriptive data about individual variants, including their detection status in each ctDNA assay, are provided in variant classification tables within the Source Data Excel file. These tables were used to generate variant detection heat maps and other data plots. Raw sequencing data have been deposited to the National Center of Biotechnology Information Bioproject PRJNA677999. Variant calls generated by each assay vendor (in VCF format) and panel region files (in BED format) can be accessed at the following link: https://figshare.com/projects/SEQC2_Onco-panel_Sequencing_Working_Group_-_Liquid_Biopsy_Study/94523. Source data are provided with this paper.
Variant call sets for each ctfDNA sequencing assay were generated by internal bioinformatics pipelines by each assay vendor. Although these pipelines are not open source, detailed descriptions and relevant software version numbers are provided in the Supplementary Methods. All data plots were generated using R (v3.5 or later) or GraphPad Prism (v8).
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All SEQC2 participants freely donated their time, reagents and computing resources for the completion and analysis of this project. We thank our expert colleague, S.-J. Dawson, for providing useful feedback during manuscript preparation. We acknowledge the following funding sources: NHMRC grants APP1108254 and APP1114016 (to T.R.M.), BAA grant HHSF223201510172C (to D.J.), Shanghai Municipal Science and Technology Major Project grant 2017SHZDZX01 (to L.S.), the National Natural Science Foundation of China grant 31720103909 (to L.S.), MRFF grant MRF1173594, Cancer Institute NSW Early Career Fellowship 2018/ECF013 and philanthropic support from the Kinghorn Foundation (to I.W.D.). The contents of the published materials are solely the responsibility of the administering institution, a participating institution or individual authors, and they do not reflect the views of any funding body listed above. This research includes contributions from, and was reviewed by, the FDA and the NIH. This work has been approved for publication by these agencies, but it does not necessarily reflect official agency policy. Certain commercial materials and equipment are identified to adequately specify experimental procedures. In no case does such identification imply recommendation or endorsement by the FDA or the NIH, nor does it imply that the items identified are necessarily the best available for the purpose.
The Garvan Institute of Medical Research has filed patent applications on synthetic controls for genomics.
Peer review information Nature Biotechnology thanks Michael Berger and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.
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Supplementary Figs. 1–7, Supplementary Tables 1–6 and Supplementary Methods
Description of synthetic ‘sequin’ mutations
Summary of variant detection across ctDNA assays
Extraction yields from synthetic plasma
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Deveson, I.W., Gong, B., Lai, K. et al. Evaluating the analytical validity of circulating tumor DNA sequencing assays for precision oncology. Nat Biotechnol 39, 1115–1128 (2021). https://doi.org/10.1038/s41587-021-00857-z
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