Galleri Multi-Cancer Early Detection Results (GRAIL)

Understand the unique result structure for the Galleri multi-cancer early detection test, which returns coded enum values instead of numeric biomarkers.

Overview

The Galleri test (by GRAIL) is a multi-cancer early detection blood test available exclusively through the Quest lab provider. Unlike standard lab biomarkers that return numeric values with reference ranges, Galleri results use coded values (enums) to indicate cancer detection status, predicted cancer signal origin, and anatomical subcategories.

Result Structure Comparison

Standard Numeric Biomarker Result

Typical lab results for biomarkers like cholesterol follow this structure:

{
  "name": "Total Cholesterol",
  "slug": "total-cholesterol",
  "type": "numeric",
  "result": "195",
  "value": 195,
  "unit": "mg/dL",
  "reference_range": "< 200",
  "min_range_value": null,
  "max_range_value": 200,
  "is_above_max_range": false,
  "is_below_min_range": false,
  "interpretation": "normal",
  "timestamp": "2024-01-15T10:30:00Z",
  "loinc": "2093-3",
  "loinc_slug": "cholesterol-total-serum-plasma",
  "provider_id": "001347",
  "notes": null,
  "source_sample_id": "12345678"
}

Notice the type is "numeric", the result contains a numeric string, value contains the actual number, and unit specifies the measurement unit.

Galleri Result - No Cancer Signal Detected

When no cancer signal is detected, you receive a single result:

{
  "name": "Galleri Multi-Cancer Early Detection",
  "slug": "galleri-cancer-signal",
  "type": "coded_value",
  "result": "NOT_DETECTED",
  "value": -1,
  "unit": null,
  "reference_range": null,
  "min_range_value": null,
  "max_range_value": null,
  "is_above_max_range": null,
  "is_below_min_range": null,
  "interpretation": "normal",
  "timestamp": "2024-01-15T10:30:00Z",
  "loinc": null,
  "loinc_slug": null,
  "provider_id": "86038987",
  "notes": null,
  "source_sample_id": "12345678"
}

Galleri Results - Cancer Signal Detected

When a cancer signal is detected, you receive multiple related biomarker results that provide detailed information about the detection:

1. Cancer Signal Detection

{
  "name": "Galleri Cancer Signal",
  "slug": "galleri-cancer-signal",
  "type": "coded_value",
  "result": "DETECTED",
  "value": -1,
  "unit": null,
  "reference_range": null,
  "min_range_value": null,
  "max_range_value": null,
  "is_above_max_range": null,
  "is_below_min_range": null,
  "interpretation": "critical",
  "timestamp": "2024-01-15T10:30:00Z",
  "loinc": null,
  "loinc_slug": null,
  "provider_id": "86038987",
  "notes": null,
  "source_sample_id": "12345678"
}

2. Cancer Signal Origin

{
  "name": "Galleri Cancer Signal Origin",
  "slug": "galleri-cancer-origin",
  "type": "coded_value",
  "result": "HEAD_AND_NECK",
  "value": -1,
  "unit": null,
  "reference_range": null,
  "min_range_value": null,
  "max_range_value": null,
  "is_above_max_range": null,
  "is_below_min_range": null,
  "interpretation": "critical",
  "timestamp": "2024-01-15T10:30:00Z",
  "loinc": null,
  "loinc_slug": null,
  "provider_id": "86038987_1",
  "notes": null,
  "source_sample_id": "12345678"
}

3. Cancer Signal Subcategory

{
  "name": "Galleri Cancer Signal Subcategory",
  "slug": "galleri-cancer-subcategory",
  "type": "coded_value",
  "result": "OROPHARYNX_HYPOPHARYNX_NASOPHARYNX_LARYNX_LIP_AND_ORAL_CAVITY_INCLUDING_ORAL_TONGUE_NASAL_CAVITY_PARANASAL_SINUSES_MAJOR_SALIVARY_GLANDS",
  "value": -1,
  "unit": null,
  "reference_range": null,
  "min_range_value": null,
  "max_range_value": null,
  "is_above_max_range": null,
  "is_below_min_range": null,
  "interpretation": "critical",
  "timestamp": "2024-01-15T10:30:00Z",
  "loinc": null,
  "loinc_slug": null,
  "provider_id": "86038987_2",
  "notes": null,
  "source_sample_id": "12345678"
}

4. Additional Information (Comment)

{
  "name": "Galleri Additional Information",
  "slug": "galleri-comment-1",
  "type": "comment",
  "result": "Squamous Cell Signal of Head and Neck, Lung, and Esophagus",
  "value": -1,
  "unit": null,
  "reference_range": null,
  "min_range_value": null,
  "max_range_value": null,
  "is_above_max_range": null,
  "is_below_min_range": null,
  "interpretation": "critical",
  "timestamp": "2024-01-15T10:30:00Z",
  "loinc": null,
  "loinc_slug": null,
  "provider_id": "86038987_3",
  "notes": "Squamous Cell Signal of Head and Neck, Lung, and Esophagus",
  "source_sample_id": "12345678"
}

Key Differences from Standard Biomarkers

Understanding these differences is crucial for proper integration:

Result Type

• Standard biomarkers: type is "numeric" or "range"
• Galleri results: type is "coded_value" or "comment"

Result Field

• Standard biomarkers: Contains numeric values as strings (e.g., "195", "<1.2")
• Galleri results: Contains enum constant names in uppercase with underscores (e.g., "DETECTED", "HEAD_AND_NECK")

Value Field

• Standard biomarkers: Contains actual numeric value (e.g., 195)
• Galleri results: Always -1 (placeholder value; actual information is in the result field)

The value field is deprecated and will eventually be removed. For Galleri results, always use the result field to extract meaningful information.

Unit Field

• Standard biomarkers: Contains measurement units (e.g., "mg/dL", "mmol/L")
• Galleri results: Always null

Interpretation Field

• Standard biomarkers: Can be "normal", "abnormal", or "critical" based on reference ranges
• Galleri results: "normal" when not detected, "critical" when cancer signal detected

Result Multiplicity

• Standard biomarkers: Typically one result per biomarker tested
• Galleri positive results: Multiple related results (signal + origin + subcategory + comments)

Provider ID Pattern

Galleri results use a consistent provider_id pattern to distinguish between the different related results:

• "86038987" - Base cancer signal detection result
• "86038987_1" - Cancer signal origin
• "86038987_2" - Cancer signal subcategory
• "86038987_3" - Additional information/comments

Enum Value Reference

Galleri Cancer Signal

Description: Indicates whether a cancer signal was detected in the Galleri test.

Field: BiomarkerResult.result when type is "coded_value" and provider_id is "86038987"

Possible Values:

DETECTED
NOT_DETECTED

Galleri Cancer Origin

Description: When a cancer signal is detected, indicates the predicted tissue of origin for the cancer signal. This represents the general anatomical location or cell lineage where the cancer may have originated.

Field: BiomarkerResult.result when type is "coded_value" and provider_id is "86038987_1"

Possible Values (21 total):

ANUS
BLADDER_UROTHELIAL_TRACT
BREAST
CERVIX
COLON_RECTUM
HEAD_AND_NECK
KIDNEY
LIVER_BILE_DUCT
LUNG
NEUROENDOCRINE_CELLS_OF_LUNG_OR_OTHER_ORGANS
LYMPHOID_LINEAGE
MELANOCYTIC_LINEAGE
MYELOID_LINEAGE
OVARY
PANCREAS_GALLBLADDER
PLASMA_CELL_LINEAGE
PROSTATE
BONE_AND_SOFT_TISSUE
THYROID_GLAND
STOMACH_ESOPHAGUS
UTERUS

Galleri Cancer Subcategory

Description: Provides a more specific anatomical classification of the predicted cancer signal origin, with additional detail about the specific organs or tissue types involved.

Field: BiomarkerResult.result when type is "coded_value" and provider_id is "86038987_2"

Possible Values (21 total):

ANUS
BLADDER_RENAL_PELVIS_URETER_URETHRA
BREAST
CERVIX
COLON_RECTUM_APPENDIX
OROPHARYNX_HYPOPHARYNX_NASOPHARYNX_LARYNX_LIP_AND_ORAL_CAVITY_INCLUDING_ORAL_TONGUE_NASAL_CAVITY_PARANASAL_SINUSES_MAJOR_SALIVARY_GLANDS
KIDNEY
LIVER_INTRAHEPATIC_BILE_DUCT
LUNG_BRONCHUS
NEUROENDOCRINE_CELLS_OF_LUNG_OR_OTHER_ORGANS
LYMPHOID_LINEAGE
MELANOCYTIC_LINEAGE
MYELOID_LINEAGE
OVARY_FALLOPIAN_TUBE_PRIMARY_PERITONEUM
PANCREAS_EXTRAHEPATIC_BILE_DUCT_GALLBLADDER
PLASMA_CELL_LINEAGE
PROSTATE
SKELETAL_MUSCLE_AND_OTHER_CONNECTIVE_TISSUE_VASCULAR_TISSUE_BONE_AND_CARTILAGE
THYROID_GLAND
STOMACH_ESOPHAGUS
UTERUS

Integration Tips

Identifying Galleri Results

Galleri results can be identified in the API response by:

1. The type field will be "coded_value" or "comment"
2. The provider_id will start with "86038987"
3. The slug values will be: "galleri-cancer-signal", "galleri-cancer-origin", or "galleri-cancer-subcategory"

Handling Multiple Related Results

When a cancer signal is detected, you will receive multiple related biomarker results that should be grouped and displayed together. The provider_id field distinguishes between them:

• "86038987" - The main cancer signal detection result
• "86038987_1" - The predicted origin of the cancer signal
• "86038987_2" - The specific subcategory with detailed anatomical information
• "86038987_3", "86038987_4", etc. - Additional information and comments