GH Nice article from view of a patient…

Here’s what her recovery from a regular chest biopsy looked like:

Here’s what my recovery looked like:

A partially collapsed lung
Coughing up blood
Significant chest pain and shortness of breath
Extended monitoring for low blood pressure
Multiple chest X-rays
Extra time off from work due to pain and shortness of breath

And for all that I got inconclusive results because the team wasn’t able to get an adequate sample of tissue.

That’s not from the definitive surgery. That was from the biopsy! Invasive surgical biopsies look to me to be finished (chest and abdominal biopsies, anyway). What would you choose?


The post-procedural complications and recovery I experienced are fairly common and well-documented as “minor complications” in the literature. Looking back, I wish I had known more prior to the procedure on what to expect from a “traditional biopsy.” I also wish there was a faster, less invasive, less expensive, less traumatic way of collecting tissue.

I imagine what would have happened if I could have had a liquid biopsy instead of the traditional one: no overnight fast, no trip to New York for the biopsy. Less (or no) time off from work for me and my care partner. No panic attack, no partially collapsed lung, no pain or coughing up blood.


This is an exciting field and when it develops it’ll make invasive biopsies look like leeching.

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Guardant won’t completely eliminate tissue biopsy because liquid biopsy is not 100% accurate. Tissue Biopsy will pick up some things that liquid biopsy misses and vice versa.

Guardant’s aim is to make liquid biopsy to be used first because the results come back faster. If liquid biopsy shows a indication, then the oncologist can choose the best therapy for the biomarker. If liquid biopsy is negative, then the second step is tissue biopsy.

This was explained in the Q&A section of the last conference call:

Puneet Souda

Okay. Got it. Maybe, if I could touch on now data again and I know it’s been talked about, but if we saw the data, look, 17 samples had liquid, where liquid picked up versus the tissue, ahead of the tissue. But there were 12 samples, where there was tissue only detection. So, I just wanted to get a sense of how do you sort of position the test after that data and how – in terms of what data sets that you need beyond this in order to convince the oncologist longer-term, the liquid first paradigm is the way to go. Should we just expect that as when the final NILE data is completed for 300 plus patients or should there be more and more studies that here sort of convinced with the oncologists longer-term?

Derek Bertocci

Let me start with that and I’ll let others chime in. It’s a good question. In terms of – let me unpack that in terms of kind of multiple aspects of that question. So, the first is, neither testing modality is perfect, liquid misses some, tissue misses some as well. But what the NILE data shows is there’s a ideal sequence to how you position these tests. if we think about what we’re trying to establish, it’s a blood first paradigm, not a blood only paradigm. And so what we find is because of the shorter turnaround time, the ease of use and the completeness of our liquid solution by sequencing liquid ahead of tissue and refluxing the negative tested patients to tissue, you actually get more complete biomarker testing faster in first line non-small cell lung cancer.…



Guardant won’t completely eliminate tissue biopsy because liquid biopsy is not 100% accurate.

Yet… not yet. Given all that we are learning, those days may well be here in 10-15 years or so. It’s an arduous process to build the database of what shows up in the blood for which cancer/tumor. It will take time but I would not be surprised at all if we don’t do a biopsy on the majority of cancers in a few years.

I can even see a point in several years when you turn 40 or 50 you get a blood test to look for the common cancers with a blood test and then you get it every year thereafter. Kinda like a mammogram for women. Men get tested for colon, lung, prostate, liver, pancreatic, bladder, renal. Swap out prostate for breast in women and you get most of them. We do live in amazing medical times for sure.



We do live in amazing medical times for sure.

We live in the future.

I just watched JFK’s moon speach. On my cell phone, in my easy chair.

I will listen to a play list of music in my work truck via my phone and Amazon.

Last night I made contact with some one that might have a job for me building micro grids in Sierra Leon.

A robot made your mornings bacon.

And your car.

Virtual machines talk to each other over virtual networks. They even commit virtual crimes and are caught by virtual security.

I used a computer stabilized drone to take arial video of the mid west flooding and post it to my virtual friends on social media.

Scientist have reversed aging in lab rats and made an earth worm immortal.

And JFK thought things were moving fast.



In this case, a biopsy was necessary to make the diagnosis of lymphoma. And gene tests are not necessary for guiding treatment in most types of lymphomas. Had Guardant 360 been available 11 years earlier, it likely would not have helped her. I believe liquid biopsy will likely replace tissue-based gene tests, but to make a definite diagnosis of cancer type, examination of tissue will still be necessary.

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