Although targeted NGS of circulating tumor DNA (ctDNA) identified no aberrations in the EGFR, ROS-1, MET, HER-2, RET, or BRAF genes, we found a rare SLC8A1 downstream intergenic region ALK fusion at a 43.3% mutant allele frequency in the node biopsy specimen sample (Fig. 2A and B) which was not found in peripheral blood (Fig. 3H). This evidence concerns the gene ALK and neoplasm.