The American Society of Clinical Oncology (ASCO) recently released a guideline on circulating tumor DNA (ctDNA) testing. The guideline, Circulating Tumor DNA Testing in Solid Tumors and Lymphoma features five recommendations regarding when ctDNA testing is appropriate, when to combine it with standard-of-care testing, and more. 

The ASCO guideline also provides clinicians with direction on patient-clinician communication. Some of this guidance includes suggestions to clarify the goals of care so that patients understand the potential outcomes, provide patients with information on the pros and cons of treatment, and ensure patients feel informed and reassured without being misleading. 

Outlined below are the five recommendations from the 2026 ASCO ctDNA testing guideline. For the most thorough look at the following five recommendations, along with the accompanying supportive evidence and qualifying statements, view the full-text version. 

Recommendations from the 2026 ASCO ctDNA Testing in Solid Tumors and Lymphoma Guideline
  1. Outside of a clinical trial, circulating tumor DNA (ctDNA) testing should only be offered if the results of testing could be applied to clinical decision making. ctDNA testing to determine eligibility for participation in a clinical trial is reasonable and appropriate.
  2. ctDNA testing for tumor genetic alterations may be used as first assessment, replacement, or as additional testing to tissue-based testing in situations where: Tissue testing is challenging, unfeasible, or tumor tissue biopsy represents unacceptable risks to the patient; Tissue testing results may not be available within a clinically actionable time frame to determine appropriate management options; A drug's regulatory approved indication allows for or requires ctDNA testing. If ctDNA testing results are negative, inconclusive, or inconsistent with the clinical scenario, tissue-based confirmation should be sought.
  3. Other than testing for tumor genetic alterations (Recommendation 2), ctDNA testing may be offered together with standard-of-care testing and procedures if: A specific, evidence-based action can be taken with the results; There is conflict or ambiguity with standard-of-care assessment that may be resolved by ctDNA testing.
  4. ctDNA testing is not recommended as a replacement for any other form of testing, except as noted in Recommendations 2 and 3.
  5. Fractional, percentage, or concentration-based measures of ctDNA or total cfDNA concentration are not recommended as a surrogate measure of disease burden to make treatment decisions outside the context of a clinical trial or clinical research.

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