Natera’s Signatera minimal residual disease (MRD) test has been included in updated NCCN guidelines for muscle-invasive bladder cancer. The National Comprehensive Cancer Network recommends Genentech’s Tecentriq (atezolizumab) for MRD-positive patients within one year after cystectomy, with broader consideration of tumor-informed MRD testing for risk stratification. The NCCN update specifies tests that are FDA-approved, tumor-informed, multiplex, and use PCR-based next-generation sequencing for circulating tumor DNA. In a pivotal context, the guideline inclusion followed Phase 3 IMvigor011 results where Tecentriq improved disease-free survival versus placebo in ctDNA-positive patients. Commercial impact is likely tied to payer coverage: the report notes Cigna has added coverage aligned to NCCN category recommendations, potentially accelerating real-world utilization of tumor-informed MRD in bladder cancer post-surgery management.