case_images: PMC10846301_01
case_images: Timeline describing the clinical course, samples collected for sequencing and treatments administered (upper). Imaging assessments were performed using computed tomography scans to track treatment efficacy (lower); the CT images revealed three scenarios in which the lesion size changed before and after osimertinib administration; VATS, video-assisted thoracoscopic surgery.
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case_images: The tumor and plasma samples collected and the clinical course are summarized in  Figure 1 . In addition, the detailed clinicopathological and radiological characteristics of all eight surgical specimens are summarized in  Figure 2A  and  Supplementary Table 1 .
case_images: Radiological features and mutational characteristics of GGOs. (A) CT images of the eight nodules recognized by the artificial intelligence mode; (B) heatmap showing the presence (blue) or absence (gray) of somatic mutations in each tumor; the mutations highlighted in red are clinically actionable variants; (C) phylogenetic trees indicating the clonal structure of the tumors sequenced from this patient; (D) the number of shared somatic mutations between tumor pairs; CT, computed tomography.
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case_images: In addition, the detailed clinicopathological and radiological characteristics of all eight surgical specimens are summarized in  Figure 2A  and  Supplementary Table 1 . Table 1 ). A phylogenetic tree and shared mutation analysis showed limited relatedness between tumors ( Figures 2C, D ). Based on these two shared mutations, clonal relationships between T0104 and T0103 and between T0104 and T0201 were established, indicating the presence of metastases. Therefore, the patient was diagnosed with both
case_images: Detection of somatic mutations in four plasma and eight tissue samples from this patient (A) molecular mutational profiling of tissue DNA and plasma-derived ctDNA (top 25 mutations); (B) the maximal allele fraction of ctDNAs in 4 blood sample; ctDNA mutation burden changes were correlated with treatment response; ctDNA, circulating tumor DNA; Max AF, maximal allele fraction.
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case_images: MPLC and IM. Mutations from multiple tissue tumors were detected in B01 and B03 ( Figure 3A ). Notably, mutations in T0103 and T0104 from the first surgery were detected in B03 and B04 ( Figure 3A ). B04, 11.42%), and the mutation burden (Max AF) of ctDNA increased with disease progression (B02, 1.65% vs. B03, 12.79%) ( Figure 3B ).