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Licensed Unlicensed Requires Authentication Published by De Gruyter December 24, 2019

Plasma vs. serum in circulating tumor DNA measurement: characterization by DNA fragment sizing and digital droplet polymerase chain reaction

  • Jee-Soo Lee , Miyoung Kim , Moon-Woo Seong , Han-Sung Kim , Young Kyung Lee and Hee Jung Kang EMAIL logo



Choosing the specimen type is the first step of the pre-analytical process. Previous reports suggested plasma as the optimal specimen for circulating tumor DNA (ctDNA) analysis. However, head-to-head comparisons between plasma and serum using platforms with high analytical sensitivity, such as droplet digital polymerase chain reaction (ddPCR), are limited, and several recent studies have supported the clinical utility of serum-derived ctDNA. This study aimed to compare the DNA profiles isolated from plasma and serum, characterize the effects of the differences between specimens on ctDNA measurement, and determine the major contributors to these differences.


We isolated cell-free DNA (cfDNA) from 119 matched plasma/serum samples from cancer patients and analyzed the cfDNA profiles by DNA fragment sizing. We then assessed KRAS mutations in ctDNA from matched plasma/serum using ddPCR.


The amount of large DNA fragments was increased in serum, whereas that of cfDNA fragments (<800 bp) was similar in both specimens. ctDNA was less frequently detected in serum, and the KRAS-mutated fraction in serum was significantly lower than that in plasma. The differences in ctDNA fractions between the two specimen types correlated well with the amount of large DNA fragments and white blood cell and neutrophil counts.


Our results provided detailed insights into the differences between plasma and serum using DNA fragment sizing and ddPCR, potentially contributing to ctDNA analysis standardization. Our study also suggested that using plasma minimizes the dilution of tumor-derived DNA and optimizes the sensitivity of ctDNA analysis. So, plasma should be the preferred specimen type.

Corresponding author: Hee Jung Kang, MD, PhD, Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, Republic of Korea, Phone: +82-31-380-3929, Fax: +82-31-380-1798

Funding source: Hallym University

Award Identifier / Grant number: HURF-2018-01

Funding statement: This work was supported by the Hallym University Research Fund (HURF-2018-01).

  1. Author contributions: All authors have accepted responsibility for the entire content of the submitted manuscript and have approved its submission.

  2. Employment or leadership: None declared.

  3. Honorarium: None declared.

  4. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


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Received: 2019-08-23
Accepted: 2019-11-30
Published Online: 2019-12-24
Published in Print: 2020-03-26

©2020 Walter de Gruyter GmbH, Berlin/Boston

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