# Match each blood-detected clone to the lesion it comes from on the scan

Source: https://onco.cc/ideas/idea-bio1-clone-to-lesion-mapping/  
OnCo record `idea-bio1-clone-to-lesion-mapping` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Blood tests tell you which tumour sub-populations are growing; scans tell you which lesions are growing. Joining the two would tell you where to biopsy or irradiate.

## Summary

Tissue-of-origin methylation, lesion-specific private mutations from multi-site biopsies, and lesion volume kinetics from serial imaging could be combined in a joint model that assigns plasma clone fractions to anatomical lesions. This would let clinicians direct local therapy at the lesion carrying the expanding resistant clone without biopsying every site.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A joint ctDNA-imaging model localises the source lesion of an emerging resistant clone correctly in most cases when validated against multi-site biopsy or autopsy.
- Rationale: Lesion-level heterogeneity is the norm in metastatic disease; ctDNA is lesion-agnostic and imaging is genotype-agnostic. The two are rarely modelled together.
- Proposed test: Retrospective model building on rapid autopsy cases with serial plasma and imaging in life; prospective validation in patients undergoing multi-site biopsy at progression.
- Maturity: speculative
- Actor: data

## Sources

- Bottleneck evidence (Tumour heterogeneity and clonal evolution): Gerlinger et al., Intratumor heterogeneity and branched evolution (NEJM 2012): https://doi.org/10.1056/NEJMoa1113205

## Connected records

- technologies: [DNA methylation profiling](https://onco.cc/technologies/methylation-profiling/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [PET/CT](https://onco.cc/technologies/pet-ct/), [Whole-body MRI](https://onco.cc/technologies/whole-body-mri/)
- bottlenecks: [Metastasis is understood least and studied last](https://onco.cc/bottlenecks/b-metastasis-biology/), [Tumour heterogeneity and clonal evolution](https://onco.cc/bottlenecks/b-tumor-heterogeneity/)

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