OncoSKY and PancreaSeq advance molecular triage

Cancer testing still often relies on a tiny tissue sample, even when a tumor can differ from one spot to another and change after treatment. Blood-based circulating tumor DNA tests are built to sample those fragments in real time. (mdpi.com) (nature.com) That is the point behind OncoSKY’s explainer on why liquid biopsy can find mutations a tissue biopsy misses. Reviews published in 2025 say tissue can give only a local, static snapshot, while circulating tumor DNA can reflect spatial heterogeneity and clonal evolution. (nature.com) (mdpi.com) One 2025 comparative study matched pre-mortem liquid biopsy with 56 postmortem tissue samples from eight patients with solid tumors. The liquid biopsy profiles overlapped with tissue mutations by 33% to 92% and also identified resistance mutations tissue sampling had overlooked. (mdpi.com) Pancreatic cysts pose a related sampling problem: many are found on imaging, but only a minority are cancerous or on a path toward cancer. The fluid collected by endoscopic ultrasound-guided fine-needle aspiration is often scant, so every test competes for the same small specimen. (pancreaseq.com) (nordx.testcatalog.org) A multi-institutional validation study published on December 12, 2025 tested the PancreaSeq Genomic Classifier on 241 patients with follow-up diagnoses. The assay combines DNA and RNA sequencing to classify cyst type and estimate malignant potential from pancreatic cyst fluid. (link.springer.com) (pmc.ncbi.nlm.nih.gov) In that cohort, PancreaSeq Genomic Classifier reached 94.6% sensitivity and 96.4% specificity for mucinous cysts, with an area under the curve of 0.955. For advanced neoplasia, defined as high-grade dysplasia or pancreatic ductal adenocarcinoma, sensitivity was 86.6% and specificity was 97.9%. (link.springer.com) The same paper said older markers performed worse on sensitivity. Increased fluid viscosity, carcinoembryonic antigen, worrisome imaging features, malignant cytopathology, and high-risk stigmata all posted lower sensitivity or lower area-under-the-curve values in the head-to-head comparison. (link.springer.com) The classifier also improved on the earlier DNA-only PancreaSeq assay. The study reported statistically higher sensitivity for mucinous cysts with PancreaSeq Genomic Classifier at p below 0.001 and for advanced neoplasia at p equals 0.031, while specificity remained high. (link.springer.com) A separate Gastrointestinal Endoscopy study, posted in 2025, looked at 441 adults seen in a high-risk pancreatic lesion clinic from 2016 to 2022. It evaluated how next-generation sequencing results were used in management decisions, including surgery and cyst-type differentiation. (giejournal.org) Taken together, the liquid-biopsy and pancreatic-cyst data push the same workflow change: run molecular testing earlier, before limited material is exhausted by repeat passes or broad workups. The practical goal is triage — deciding which patients need surgery, which need surveillance, and which need more targeted follow-up testing. (nature.com) (link.springer.com)