This study evaluated the clinical utility of presurgical circulating tumor DNA (ctDNA) detection in predicting prognosis for patients with early-stage non-small cell lung cancer (NSCLC). Researchers analyzed plasma samples from 895 patients with EGFR/ALK wild-type stage I–II NSCLC to investigate the correlation between ctDNA status, tumor volume, PET metabolic activity, histologic subtypes, and pathologic TNM upstaging. The results showed that presurgical ctDNA detection was significantly associated with increased recurrence risk in stage I lung adenocarcinoma (LUAD) (2-year recurrence-free survival: 69% vs. 91%, p<0.001) and was also linked to higher-grade tumors and increased PD-L1 expression. Aview (Coreline Soft) was used to quantify CT-based tumor volume and analyze PET SUVmax values to assess their relationship with ctDNA detection