Liquid biopsy in Oncology: Results of a Delphi consensus study endorsed by the AIOM-SIAPEC/IAP-SIBioC-SIF Italian scientific societies

Liquid biopsy (LB) offers a minimally invasive alternative to tissue biopsy by detecting tumor-derived analytes in biological fluids. Nonetheless, its adoption is limited by variability in methodologies. Therefore, this study used a modified RAND/UCLA approach involving 23 experts of the field, providing two questionnaires that assessed agreement on 22 items. Consensus was reached for all the pre- and post-analytical phase items, agreeing on the pivotal role of plasma cfDNA. Conversely, opinions varied regarding other biomarkers and biological samples. Furthermore, turnaround time and disease setting resulted as two of the most important analytical parameters for choosing testing methodology. Particularly, a complementary tissue-liquid approach with sampling interval ≤2 weeks was preferred. To conclude, a strong consensus on sample handling, biomarker prioritization, and clinical applications is achieved. However, significant heterogeneity remains regarding novel biomarkers, sampling strategies, and costs. Standardization and validation are needed to enhance the clinical adoption of LB.