Beyond Capture Efficiency: A Multidimensional Framework for Benchmarking Circulating Tumor Cell Isolation Technologies

Metastasis remains the major cause of cancer-related mortality, and circulating tumor cells (CTCs) are both candidate liquid-biopsy biomarkers and plausible intermediates of metastatic dissemination. Because CTCs are extremely rare in peripheral blood, platform comparisons have often focused solely on recovery. That focus is insufficient for applications that depend on the quality of the recovered material, including single-cell profiling, short-term culture, and functional testing. Here, we compared four CTC isolation approaches: TellDx CTC System, Genesis System, RosetteSep, and flow cytometry, using spike-in experiments in human blood. Capture efficiency was evaluated across all four platforms; purity was assessed for TellDx, Genesis, and RosetteSep; and post-isolation GFP signal persistence in culture was assessed for TellDx and Genesis as an exploratory proxy for short-term post-isolation preservation. Under the conditions tested, TellDx showed the highest recovery (88.1% +/- 3.7%), followed by Genesis (40.6% +/- 12.1%), RosetteSep (36.5% +/- 9.0%), and flow cytometry (7.6% +/- 4.5%). TellDx also showed the highest purity score (3.76), whereas Genesis (2.25) and RosetteSep (2.09) did not differ substantially. In the short-term culture assay, TellDx-derived samples retained a higher normalized GFP signal than Genesis-derived samples at 48 h and 72 h. To synthesize these readouts, we propose the Recovery Performance Index (RPI), a composite score integrating recovery, purity, and post-isolation signal persistence. Within this experimental framework, TellDx achieved the highest RPI. These data support two conclusions. First, platform benchmarking for CTC workflows benefits from multidimensional evaluation rather than recovery alone. Second, under this spike-in model and within the specific workflows used here, TellDx performed best among the platforms tested. The principal contribution of this study is therefore the establishment of a practical benchmarking framework that can be expanded in future work using clinical samples, multiple CTC phenotypes, and orthogonal viability assays.