# Bank three spatially separate tumour blocks from every resection

Source: https://onco.cc/ideas/idea-bio1-multiregion-blocks-default/  
OnCo record `idea-bio1-multiregion-blocks-default` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Hospitals usually keep one piece of a removed tumour. Keeping three pieces from different parts would show how varied the tumour is, at almost no extra cost.

## Summary

TRACERx showed that a single region misses subclonal drivers and under-calls copy-number heterogeneity in a large share of lung cancers. Pathology protocols could mandate three or more spatially annotated blocks (core, edge, invasive front) frozen and formalin-fixed for every resected solid tumour, with the region map stored with the specimen. The marginal cost is technician time; the payoff is a national multi-region resource attached to outcomes.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Routine three-block banking changes the reported driver or clonality status in at least 10 percent of resected tumours and improves recurrence prediction over single-block profiling.
- Rationale: Multi-region sequencing consistently reveals branch drivers and chromosomal instability that single biopsies miss; TRACERx and PCAWG show heterogeneity metrics are prognostic. Banking is cheap; sequencing can follow later.
- Proposed test: Two-year pilot in five surgical centres: implement the protocol, sequence a random 500-case subset, and measure the discordance rate between single-block and three-block calls and the improvement in relapse prediction.
- Maturity: preclinical-evidence
- Actor: clinic

## Sources

- TRACERx (NCT01888601): https://clinicaltrials.gov/study/NCT01888601

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Renal cell carcinoma](https://onco.cc/cancers/rcc/)
- technologies: [Comprehensive genomic profiling](https://onco.cc/technologies/cgp/), [Whole-exome & whole-genome sequencing](https://onco.cc/technologies/wes-wgs/)
- institutions: [Cancer Research UK](https://onco.cc/institutions/cruk/), [The Francis Crick Institute](https://onco.cc/institutions/francis-crick/)
- bottlenecks: [Data silos](https://onco.cc/bottlenecks/b-data-silos/), [Tumour heterogeneity and clonal evolution](https://onco.cc/bottlenecks/b-tumor-heterogeneity/)

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