Natera’s Signatera minimal residual disease (MRD) test gained formal inclusion in new National Comprehensive Cancer Network (NCCN) guidelines for muscle-invasive bladder cancer, creating an important coverage signal for MRD-driven decision-making. The NCCN update recommends Tecentriq (atezolizumab) for patients who are MRD-positive within one year after cystectomy. The guidelines also broaden consideration of tumor-informed MRD testing for risk stratification and to guide use of adjuvant immunotherapy, specifying that tests must be FDA-approved and use tumor-informed multiplex PCR next-generation sequencing for circulating tumor DNA. Signatera’s status as the only FDA-approved companion diagnostic for this indication is credited with narrowing the recommendation to Natera’s assay. The update followed Phase 3 IMvigor011 results in which ctDNA-positive patients after cystectomy were randomized to Tecentriq or placebo; disease-free survival was nearly doubled with Tecentriq (9.9 months vs 4.8 months). Overall survival was also longer in the Tecentriq arm, and survival rates at two years favored active treatment. Analysts noted that NCCN category inclusion can unlock commercial reimbursement momentum, and the test is already covered by Cigna for this use case, supporting near-term addressable market growth expectations.