Is a combination of Galleri (multi-cancer early detection) blood test, liquid biopsy, chest X-ray, and ultrasound sufficient to detect kidney cancer recurrence?

From the Guidelines

A combination of Galleri blood test, liquid biopsy, chest X-ray, and ultrasound is not considered sufficient as a standalone approach for detecting kidney cancer recurrence, and contrast-enhanced CT scans or MRIs are still the gold standard for monitoring kidney cancer recurrence. The use of liquid biopsies, such as the Galleri test, can detect circulating tumor DNA and may identify recurrence before it's visible on imaging, but they are still considered complementary tools rather than replacements for standard imaging surveillance 1. Ultrasound is useful for detecting changes in the kidney but has limitations in identifying small recurrences or distant metastases. Chest X-rays can detect lung metastases but may miss smaller lesions that CT scans would identify.

For comprehensive surveillance, patients should follow guidelines that typically recommend periodic contrast-enhanced cross-sectional imaging (CT or MRI) based on their risk category, with frequency ranging from every 3-6 months initially to annually in later years, as recommended by the American College of Radiology 1. The specific surveillance protocol should be individualized based on the patient's original cancer stage, grade, time since treatment, and risk factors for recurrence. Some key factors to consider in the surveillance protocol include:

• Tumor size and stage
• Presence of tumor necrosis or microvascular invasion
• Patient symptoms, such as weight loss, night sweats, or shortness of breath
• Laboratory results, including blood urea nitrogen/creatinine, urinalysis, and estimated glomerular filtration rate

According to the most recent guidelines, for low-risk/T1 tumors, chest imaging should be performed every 12 to 24 months for 3 to 5 years, and abdominal imaging should be performed at the discretion of the physician, with some recommending a baseline study between 3 and 12 months after partial nephrectomy, then yearly for 3 to 5 years 1. The use of a combination of Galleri blood test, liquid biopsy, chest X-ray, and ultrasound may be helpful in detecting kidney cancer recurrence, but it should not replace the standard imaging surveillance with contrast-enhanced CT scans or MRIs.

From the Research

Detection Methods for Kidney Cancer Recurrence

• A combination of Galleri (multi-cancer early detection) blood test, liquid biopsy, chest X-ray, and ultrasound may be used to detect kidney cancer recurrence.
• The Galleri test is a multi-cancer early detection test that has shown high specificity in preliminary findings 2, 3.
• Liquid biopsy techniques, including circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and cell-free DNA (cfDNA), have demonstrated success in cancer detection, disease characterization, and ongoing disease monitoring 4.
• Chest X-ray and ultrasound are imaging techniques that can be used to detect tumors and metastases.

Limitations and Challenges

• Conventional anatomic imaging is limited in detecting kidney cancer recurrence 5.
• Liquid biopsy in renal cell carcinoma (RCC) poses unique challenges, including low ctDNA shedding and significant intratumoral heterogeneity 4.
• The clinical application of liquid biopsy in RCC requires standardized protocols and further validation in large, diverse cohorts 4.

Potential Applications

• The combination of Galleri test, liquid biopsy, chest X-ray, and ultrasound may provide a comprehensive approach to detecting kidney cancer recurrence.
• Integrating liquid biopsy with advanced imaging techniques and leveraging artificial intelligence may improve RCC diagnostics and patient management 4.
• Further research is needed to establish the clinical utility of these detection methods in kidney cancer recurrence 5, 2, 3, 4.