Smaller, cheaper, faster: where next for liquid biopsies?

Introduction: Liquid biopsy (LB) has shifted the paradigm in cancer diagnosis and management, offering a minimally invasive and dynamic approach to understanding tumor biology. Advanced next-generation sequencing (NGS) technologies have significantly improved the accuracy of LB results, enhancing both its analytical and clinical validity. However, tissue biopsy (TB) remains the gold standard for molecular analysis, often negatively impacting the molecular profiling of tumor patients owing to inadequate tissue samples, or lack thereof. Areas covered: In this scenario, LB has become a dynamic and easily-to-handle, integrative source of nucleic acids, filling the gap in tissue sample availability for molecular profiling. Moreover, cost-effectiveness analyses have also shown that when LB is correctly applied to clinical settings, healthcare spending can be optimized, enabling an increase in quality-adjusted life years at an affordable cost. Expert opinion: While LB has the potential to reduce the need for invasive TB and expedite treatment decisions, its cost-effectiveness hinges on long-term clinical outcomes and healthcare resource utilization. In this scenario, 'new era platforms' endowed with advanced liquid handling technologies could not only improve its efficiency and reduce costs but also enable higher-throughput experiments with much larger sample sizes.