Circulating Tumour DNA Surveillance in Early Breast Cancer Tumour Informed ctDNA Monitoring, Recurrence Prediction and Comparative Performance against Imaging

Dr. Rashmi Gautam, Dr. Nidhi Tyagi, Anjali Yadav

Circulating Tumour DNA; Ctdna; Breast Cancer; Minimal Residual Disease; Recurrence; Tumour-Informed Assay; Surveillance

Circulating tumour DNA (ctDNA) detection in plasma offers the prospect of identifying minimal residual disease and impending recurrence in patients with early-stage cancer at intervals before conventional imaging or biomarker surveillance can. We undertook a prospective surveillance cohort study of 245 patients with stage I-III breast cancer who underwent tumour-informed ctDNA testing at completion of curative therapy and at 3-monthly intervals for 36 months. Among 218 patients with adequate follow-up, ctDNA was detected at one or more time points in 47 patients (21.6%). Three-year distant disease-free survival was 92.1% in patients with sustained ctDNA negativity compared with 36.2% in those with ctDNA positivity during surveillance. Among ctDNA-positive patients who subsequently developed recurrence, ctDNA detection preceded clinical or imaging recurrence by a median of 8.4 months. ctDNA showed substantially better discrimination for predicting recurrence (AUC 0.93) than CA 15-3 (AUC 0.72) or conventional imaging (AUC 0.84). Strongest independent predictors of ctDNA positivity included triple-negative subtype, node-positive disease, large tumour size, grade 3 histology, lymph vascular invasion, and high Ki-67. The findings support tumour-informed ctDNA surveillance as a high-performance recurrence monitoring tool with substantial lead-time advantage over conventional modalities.

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