Clinical Management of Circulating Tumor DNA in Breast Cancer: Detection, Prediction, and Monitoring

Despite substantial progress in the diagnosis and treatment of breast cancer, current therapeutic regimens exhibit limitations, necessitating the identification of more robust biomarkers to optimize personalized strategies. Circulating tumor DNA (ctDNA), as a non-invasive liquid biopsy modality, overcomes the inherent constraints of biopsies in capturing tumor heterogeneity. Accumulating evidence from prospective cohort studies demonstrates the clinical utility of ctDNA in risk stratification, guidance of therapeutic decision-making, recurrence surveillance and other clinical applications. Furthermore, ctDNA profiling enhances real-time pharmacodynamic monitoring and accelerates drug development by identifying molecular responders. The methodical requirements and challenges inherent in implementing liquid biopsy assessments in the clinic are examined. These encompass critical pre-analytical variables, the need for highly sensitive and specific analytical techniques, standardization of assays and bioinformatics pipelines across laboratories and the complexities of interpreting results. This review synthesizes current evidence supporting ctDNA integration into breast cancer management frameworks and systematically addresses its methodological challenges and clinical limitations.