In particular, breast cancers are known to exhibit a high level of intra-tumor variability for standard biomarkers such as estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR), and the proliferative marker Ki67, which can result in divergent outcomes7. This evidence concerns the gene ESR1 and breast carcinoma.