biostudies-literatureUnknown17(18)Shimizu H<b>Background</b>: Blood-based comprehensive genomic profiling (CGP), a form of liquid biopsy, is often used for biliary tract cancer (BTC) when tissue-based CGP (tissue CGP) is unavailable, despite lower detection rates. This study explored factors linked to detecting actionable genomic alterations to optimize its use. <b>Methods</b>: We retrospectively analyzed BTC cases in Japan's C-CAT (June 2019-January 2025), restricting panel comparisons to FoundationOne^® CDx (F1; n = 5019) and FoundationOne^® Liquid CDx (F1L; n = 1550). Missing covariates were handled by multiple imputations (m = 20). Between-panel balance used 1:1 propensity-score matching (caliper 0.2). Outcomes were modeled with logistic regression. Targets included MSI-H, TMB-H, <i>FGFR2</i>/<i>RET</i>/<i>NCancers3071https://www.ebi.ac.uk/biostudies/studies/S-EPMC12468581biostudies-literatureFactors Associated with the Detection of Actionable Genomic Alterations Using Liquid Biopsy in Biliary Tract Cancer.PMC12468581Ohira RSuzuki ROhira HAsama HShimizu HOsawa KSato KKudo KSugimoto MfalseFactors Associated with the Detection of Actionable Genomic Alterations Using Liquid Biopsy in Biliary Tract Cancer.<b>Background</b>: Blood-based comprehensive genomic profiling (CGP), a form of liquid biopsy, is often used for biliary tract cancer (BTC) when tissue-based CGP (tissue CGP) is unavailable, despite lower detection rates. This study explored factors linked to detecting actionable genomic alterations to optimize its use. <b>Methods</b>: We retrospectively analyzed BTC cases in Japan's C-CAT (June 2019-January 2025), restricting panel comparisons to FoundationOne^® CDx (F1; n = 5019) and FoundationOne^® Liquid CDx (F1L; n = 1550). Missing covariates were handled by multiple imputations (m = 20). Between-panel balance used 1:1 propensity-score matching (caliper 0.2). Outcomes were modeled with logistic regression. Targets included MSI-H, TMB-H, <i>FGFR2</i>/<i>RET</i>/<i>N2025-01-01T00:00:00Z2025 Sep2026-05-02T03:10:25.072Z2026-05-02T03:07:38.207ZS-EPMC124685814100891210.3390/cancers17183071