{"entity":{"id":"idea-bio1-clone-to-lesion-mapping","kind":"idea","name":"Match each blood-detected clone to the lesion it comes from on the scan","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Tumour heterogeneity and clonal evolution): Gerlinger et al., Intratumor heterogeneity and branched evolution (NEJM 2012)","url":"https://doi.org/10.1056/NEJMoa1113205"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":["liquid-biopsy","pet-ct","whole-body-mri","methylation-profiling"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-tumor-heterogeneity","b-metastasis-biology"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"small","horizonYears":4},"route":"/ideas/idea-bio1-clone-to-lesion-mapping/","neighbours":{"technology":[{"id":"methylation-profiling","kind":"technology","name":"DNA methylation profiling","route":"/technologies/methylation-profiling/"},{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/"},{"id":"whole-body-mri","kind":"technology","name":"Whole-body MRI","route":"/technologies/whole-body-mri/"}],"bottleneck":[{"id":"b-metastasis-biology","kind":"bottleneck","name":"Metastasis is understood least and studied last","route":"/bottlenecks/b-metastasis-biology/"},{"id":"b-tumor-heterogeneity","kind":"bottleneck","name":"Tumour heterogeneity and clonal evolution","route":"/bottlenecks/b-tumor-heterogeneity/"}]}}