Liquid biopsy in oncology practice: A global survey by the Young Committee of the International Society of Liquid Biopsy (ISLB).

BACKGROUND

Liquid biopsy is a transformative tool for precision oncology, yet its clinical use remains variable across healthcare systems, and barriers to its implementation are poorly characterized. This survey aims to assess perceptions and practices related to liquid biopsy in oncology practice worldwide.

METHODS

A cross sectional, web-based survey was distributed to oncology providers worldwide from November 2024 to December 2025. The survey captured clinical practice characteristics, liquid biopsy uses and workflows, interpretation practices, reimbursement patterns, molecular tumor board (MTB) access, and perceived clinical- and system-level barriers. Descriptive statistics and subgroup comparisons were performed across geographic region, country income level, work setting, years in independent practice, and practice type.

RESULTS

Responses from 393 participants across 59 countries were analyzed, with 53% practicing in Europe. Most were medical oncologists (90%) self-identified as specialists (68%), practicing in academic centers (78%), and in high-income countries (70%). Liquid biopsy use was variable: 83% of respondents used it in ≤50% of patients, with pronounced differences across all subgroups (all p < 0.01). Circulating tumor DNA (ctDNA) testing predominated (77%), while circulating tumor cell (CTC) use was uncommon (4% alone; 18% in combination with ctDNA). Clinicians in high-income countries, academic settings, and specialists were more likely to have structured workflows and institutional support for test-ordering. Interpretation practices varied, with most respondents relying on self-interpretation (36%) or vendor reports (30%); MTB-based primary interpretation was rare overall (4%), except in Northwestern Europe (23%). MTB availability and use varied substantially across regions and settings. Payment mechanisms differed markedly: government coverage predominated in Europe, private insurance in North America, and patient self-pay in Africa, Asia, and South/Central America-Caribbean. Cost (67%), test availability (55%), difficulty interpreting results (48%), and turnaround time (47%) were the most frequently cited barriers, with cost demonstrating the greatest regional variability (p < 0.001). Most clinicians rated liquid biopsy as important (88%) and felt confident applying results (80%), though both varied significantly by region.

CONCLUSIONS

These results highlight the high perceived value of liquid biopsy testing, while informing region- and setting-specific differences and challenges, which could be used to guide strategies to implement liquid biopsy in cancer care worldwide.