OnCo
ideasIdea

Bank three spatially separate tumour blocks from every resection

Hospitals usually keep one piece of a removed tumour. Keeping three pieces from different parts would show how varied the tumour is, at almost no extra cost.

TRACERx showed that a single region misses subclonal drivers and under-calls copy-number heterogeneity in a large share of lung cancers. Pathology protocols could mandate three or more spatially annotated blocks (core, edge, invasive front) frozen and formalin-fixed for every resected solid tumour, with the region map stored with the specimen. The marginal cost is technician time; the payoff is a national multi-region resource attached to outcomes.

Hypothesis
Routine three-block banking changes the reported driver or clonality status in at least 10 percent of resected tumours and improves recurrence prediction over single-block profiling.
Rationale
Multi-region sequencing consistently reveals branch drivers and chromosomal instability that single biopsies miss; TRACERx and PCAWG show heterogeneity metrics are prognostic. Banking is cheap; sequencing can follow later.
What would test it
Two-year pilot in five surgical centres: implement the protocol, sequence a random 500-case subset, and measure the discordance rate between single-block and three-block calls and the improvement in relapse prediction.
Maturity
preclinical evidence
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks
  • Tumour heterogeneity and clonal evolution · A tumour is many tumours. Treatments that kill most cells leave the rest to grow back, changed.
  • Data silos · Records, scans, genomes and outcomes sit in separate systems that cannot talk. Every patient's experience is lost to the next.

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