Genomics Proteomics Bioinformatics. 2025 Apr 04. pii: qzaf028. [Epub ahead of print]
Jiaqi Liu,
Yalun Li,
Wanxiangfu Tang,
Tianyi Qian,
Lijun Dai,
Ziqi Jia,
Heng Cao,
Chenghao Li,
Yuchen Liu,
Yansong Huang,
Jiang Wu,
Dongxu Ma,
Guangdong Qiao,
Hua Bao,
Shuang Chang,
Dongqin Zhu,
Shanshan Yang,
Xuxiaochen Wu,
Xue Wu,
Hengyi Xu,
Hongyan Chen,
Yang Shao,
Xiang Wang,
Zhihua Liu,
Jianzhong Su.
The fragmentomics-based cell-free DNA (cfDNA) assays have recently illustrated prominent abilities to identify various cancers from non-conditional healthy controls, while their accuracy for identifying early-stage cancers from benign lesions with inconclusive imaging results remains uncertain. Especially for breast cancer, current imaging-based screening methods suffer from high false positive rates for women with breast nodules, leading to unnecessary biopsies, which add to discomfort and healthcare burden. Here, we enrolled 613 female participants in this multi-center study and demonstrated that cfDNA fragmentomics (cfFrag) is a robust non-invasive biomarker for breast cancer using whole-genome sequencing. Among the multimodal cfFrag profiles, the fragment size ratio (FSR), fragment size distribution (FSD), and copy number variation (CNV) show more distinguishing ability than Griffin, motif breakpoint (MBP), and neomer. The cfFrag model using the optimal three fragmentomics features discriminated early-stage breast cancers from benign nodules, even at a low sequencing depth (3×). Notably, it demonstrated a specificity of 94.1% in asymptomatic healthy women at a 90% sensitivity for breast cancers. Moreover, we comprehensively showcased the clinical utilities of the cfFrag model in predicting patient responses to neoadjuvant chemotherapy (NAC) and in combining with multimodal features, including radiological results and cfDNA methylation features [with area under the curve (AUC) values of 0.93-0.94 and 0.96, respectively].
Keywords: Breast cancer; Cell-free DNA methylation; Fragmentomics; Neoadjuvant chemotherapy; Whole-genome sequencing