Key Points

Diagnosis

Design and created by Guideline Central in participation with the American Society of Clinical Oncology.

Circulating Tumor DNA Testing in Solid Tumors and Lymphoma

American Society of Clinical Oncology

Publication Date: June 18, 2026

Table 1. Testing Role Framework

Term	Definitions
Replacement	A new test might substitute an old one, because it is more accurate, less invasive, less risky or uncomfortable for patients, organizationally or technically less challenging, quicker to yield results or more easily interpreted, or less costly.
First Assessment	A new test is added before the existing pathway and only patients with a particular result on the first assessment test continue the testing pathway; first assessment tests are not necessarily more accurate but usually simpler and less costly.
Additional Information	A new test: Is added after the existing pathway and may be used to limit the number of either false positive or false negative results after the existing diagnostic pathway; additional tests are usually more accurate. And/or Provides actionable information that was not previously available from the existing pathway and will meaningfully improve care.

Term

Definitions

Replacement

A new test might substitute an old one, because it is more accurate, less invasive, less risky or uncomfortable for patients, organizationally or technically less challenging, quicker to yield results or more easily interpreted, or less costly.

First Assessment

A new test is added before the existing pathway and only patients with a particular result on the first assessment test continue the testing pathway; first assessment tests are not necessarily more accurate but usually simpler and less costly.

Additional Information

A new test:

Is added after the existing pathway and may be used to limit the number of either false positive or false negative results after the existing diagnostic pathway; additional tests are usually more accurate.

And/or

Provides actionable information that was not previously available from the existing pathway and will meaningfully improve care.

Recommendation Rating Definitions

Quality of Evidence
Term		Definitions
H	- High	We are very confident that the true effect lies close to that of the estimate of the effect
M	- Moderate	We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
L	- Low	Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
VL	- Very Low	We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Strength of Recommendation
Term		Definitions
S	- Strong	In recommendations for an intervention, the desirable effects of an intervention outweigh its undesirable effects. In recommendations against an intervention, the undesirable effects of an intervention outweigh its desirable effects. All or almost all informed people would make the recommended choice for or against an intervention.
W	- Weak	In recommendations for an intervention, the desirable effects probably outweigh the undesirable effects, but appreciable uncertainty exists. In recommendations against an intervention, the undesirable effects probably outweigh the desirable effects, but appreciable uncertainty exists. Most informed people would choose the recommended course of action, but a substantial number would not.

GRADE Handbook, Schünemann, et al. 2013.

Abbreviations

cfDNA: circulating free DNA

ctDNA: circulating tumor DNA

MRI: magnetic resonance imaging

Source Citation

Lockwood CM, Messersmith HJ, Kim AS, et al. Circulating Tumor DNA Testing in Solid Tumors and Lymphoma: ASCO Guideline. JCO OP. 2026 June 16. doi: 10.1200/OP-26-00311

Disclaimer

This pocket guide is derived from recommendations in the American Society of Clinical Oncology Guideline. This resource is a practice tool based on ASCO® practice guidelines and is not intended to substitute for the independent professional judgment of the treating clinician. Practice guidelines do not account for individual variation among patients. This pocket guide does not purport to suggest any particular course of medical treatment. Use of the practice guidelines and this resource are voluntary. The practice guidelines and additional information are available at www.asco.org/molecular-testing-and biomarkers-guidelines. Copyright © 2026 by American Society of Clinical Oncology. All rights reserved.

Circulating Tumor DNA Testing in Solid Tumors and Lymphoma

Key Points

Diagnosis

Recommendation 1.

Recommendation 2.

Recommendation 3.

Recommendation 4.

Recommendation 5.

Table 1. Testing Role Framework

Discussion Points Between Patients and Clinicians Regarding the Use of CtDNA Testing

Recommendation Rating Definitions

Abbreviations

Source Citation

Disclaimer