Belay Announces NCCN Recommendation for CSF-Based Profiling in High-Grade Gliomas

CHICAGO, Ill., June 20, 2026

The National Comprehensive Cancer Network (NCCN) has updated its Clinical Practice Guidelines in Oncology for Central Nervous System (CNS) Cancers, expanding recommendations for cerebrospinal fluid (CSF)-based molecular tumor profiling to include patients with biopsy-infeasible high-grade gliomas (HGG) and glioblastoma (GBM). The update marks a significant advancement in the evolving field of CNS oncology and reflects growing recognition of liquid biopsy technologies as critical tools for tumor characterization and treatment planning. The revised guidance recommends the use of CSF-based molecular profiling in cases where surgery or tissue biopsy cannot be performed due to patient health, tumor location, or patient preference, particularly when genomic information is required to establish a diagnosis or guide therapy selection. The guideline expansion further reinforces the role of precision medicine in neuro-oncology and highlights the increasing importance of minimally invasive diagnostic technologies for patients with some of the most aggressive and difficult-to-treat brain cancers.

NCCN Broadens Role of Liquid Biopsy in CNS Cancer Care

The updated recommendations build upon previous NCCN guidance supporting CSF molecular testing in conditions such as medulloblastoma, cranial and spinal ependymoma, CNS lymphoma, and leptomeningeal metastases. By adding high-grade gliomas and glioblastoma to this growing list, the NCCN continues to expand the clinical utility of CSF-based genomic profiling across a broader spectrum of CNS malignancies. The update represents the second consecutive year in which NCCN has broadened the application of CSF molecular testing, reflecting rapid advancements in genomic technologies and increasing clinical evidence supporting their use.

Traditionally, patients with inoperable brain tumors have often relied on imaging studies and cytology findings to guide treatment decisions. However, these approaches may provide limited molecular information compared to comprehensive genomic profiling. The growing adoption of CSF liquid biopsy is helping bridge this gap by providing clinicians with access to actionable genomic insights without requiring invasive surgical procedures.

CSF Genomic Profiling Enhances Precision Oncology

The emergence of CSF comprehensive genomic profiling (CGP) has the potential to transform care for patients with challenging CNS malignancies by enabling more accurate molecular characterization of tumors. Precision oncology increasingly depends on identifying genetic alterations that can inform diagnosis, prognosis, and treatment selection. The updated NCCN recommendations align CNS oncology with broader trends in solid tumor management, where liquid biopsy technologies have become integral components of modern cancer care. By utilizing cerebrospinal fluid samples obtained through standard lumbar puncture procedures, clinicians can access critical genomic information that may otherwise be unavailable when tissue biopsy is not feasible.

Experts believe that expanded use of CSF-CGP will facilitate more personalized treatment strategies, improve clinical decision-making, and support the development of targeted therapies for patients with aggressive brain cancers. As additional research continues to validate the clinical utility of these technologies, further expansion of guideline recommendations may follow.

Growing Evidence Supports Advanced Molecular Testing

Belay Diagnostics, a company specializing in CSF-based molecular testing for CNS malignancies, highlighted the guideline update as an important milestone for the field. The company’s portfolio includes Summit™ 2.0, Ascent™, and Vantage™, a suite of CSF-specific diagnostic assays developed to provide comprehensive molecular insights from a single cerebrospinal fluid specimen. Recent clinical validation data have demonstrated high levels of sensitivity and specificity when compared with traditional tissue-based testing methods, supporting the growing role of liquid biopsy in CNS cancer management.

The NCCN also emphasizes the importance of multi-gene panel testing to assess multiple biomarkers simultaneously, further supporting the use of comprehensive genomic profiling technologies. As molecular characterization becomes increasingly central to CNS cancer diagnosis and treatment, the adoption of CSF-based testing may help improve outcomes for patients with inoperable tumors and expand access to precision medicine approaches across neuro-oncology. The guideline update represents another significant step toward integrating advanced genomic technologies into routine clinical practice for some of the most devastating forms of cancer.

Source: Belay Diagnostics press release