GNAS and neoplasm: These data are consistent with the data presented in prior reports of AA patients with ctDNA testing.46 In particular, while the absence of clinical annotation of grade in the Shaib et al. study limits its conclusions, the rate of mutations in key genes was far lower than our tissue-based cohort (KRAS: 18% vs. 56%; GNAS: 4% vs. 28%), indicating that in many cases mutations present in tumour failed detection using ctDNA.