Comprehensive benchmarking of methods for mutation calling in circulating tumor DNA

Detection of somatic mutations in cell-free DNA (cfDNA) is challenging due to low variant allele frequencies and pronounced DNA degradation. Here, we present a novel approach and resource for benchmarking of somatic variant calling algorithms in cfDNA samples from cancer patients. Using longitudinally collected cfDNA samples from colorectal and breast cancer patients, we identify patient-matched samples with high and ultra-low circulating tumor DNA (ctDNA) levels. These sample pairs, preserving patient-specific germline and somatic haematopoiesis variant backgrounds, were used to generate dilution series capturing characteristics of bona-fide cfDNA samples. To benchmark the accuracy and limit of detection of 9 somatic variant calling algorithms, we used deep Whole Genome Sequencing (WGS, 150x) and ultra-deep Whole Exome Sequencing (WES, 2,000x) to construct a reference set of ∼37,000 Single Nucleotide Variants and ∼58,000 Insertions/Deletions. We tested methods under variable ctDNA levels and depth of sequencing, generating guidelines for method choice depending on use case. Using a machine learning approach, we further evaluated the potential of fine-tuning individual variant callers, revealing features that may improve accuracy in cfDNA samples. Overall, we present a new resource for benchmarking of somatic variant calling methods in cfDNA, providing insights on method choice to realize the potential of liquid biopsies in precision oncology.