NCCN updated muscle-invasive bladder cancer guidance to include Natera’s Signatera minimal residual disease test as a tumor-informed ctDNA option after cystectomy. In the guideline update, Genentech’s atezolizumab (Tecentriq) is recommended for patients who test MRD-positive within one year of surgery. The inclusion follows data from the Phase III IMvigor011 trial, where ctDNA-positive patients after cystectomy were randomized to Tecentriq versus placebo and showed longer disease-free survival and overall survival with atezolizumab. The NCCN language requires FDA approval, tumor-informed design, multiplex methodology, and PCR-next-generation sequencing for ctDNA. From a market-access standpoint, the guideline coverage may accelerate reimbursement and uptake, especially because Cigna coverage is tied to NCCN category recommendations. Analysts noted that payer adoption has been limited for MRD more broadly, making the Signatera-specific inclusion a direct commercial catalyst.