# Tumor heterogeneity¶

DNA samples extracted from solid tumors are rarely completely pure. Stromal or other normal cells and distinct subclonal tumor-cell populations are typically present in a sample, and can confound attempts to fit segmented log2 ratio values to absolute integer copy numbers.

CNVkit provides several points of integration with existing tools and methods for dealing with tumor heterogeneity and normal-cell contamination.

## Estimating tumor purity and normal contamination¶

A rough estimate of tumor purity can usually be obtained using one or more of these approaches:

1. A pathologist can visually estimate the purity of an sample taken from a solid tumor by examination under a microscope, counting stromal and neoplastic cells.
2. If the tumor is belived to be driven by a somatic point mutation, e.g. BRAF V600E in melanoma, then that mutation is assumed to be fully clonal and its allele frequency indicates the tumor purity. This can be complicated by copy number alterations at the same site and whether the point mutation is homozygous or heterozygous, but the frequencies of other somatic mutations in the same sample may resolve this satisfactorily.
3. Larger-scale, hemizygous losses that cover germline heterozygous SNPs shift the allele frequencies of the same SNPs as they are present in the tumor sample. In a 50% pure tumor sample, for example, these SNP b-allele frequencies would shift from 50% to 67% or 33%, assuming a diploid sample (i.e. 1 of 2 copies from the normal sample and 0 or 1 of 1 copy from the tumor, depending on whether the variant allele was lost or retained). The general calculation is a bit more complicated than in #1 or #2, and can be done similarly for copy number gains and homozygous deletions.
4. The log2 ratio values of CNAs in a tumor sample correspond to integer copy numbers in tumor cells, and in aggregate these log2 values will cluster around values that indicate subclone populations, each with a given ploidy and clonality. For example, a single-copy loss in a 50% pure tumor sample will have 3/4 the coverage of a neutral site (2/2 normal copies, 1/2 tumor copies), for a log2 value of log2(.75) = -0.415. This calculation can also be generalized to other copy number states.

Software implementations of the latter three approaches can be used directly on DNA sequencing data.

## Inferring tumor purity and subclonal population fractions from sequencing¶

While inferring the tumor population structure is currently out of the scope of CNVkit, this work can be done using other third-party programs such as PureCN, THetA2, PyClone, or BubbleTree. Each of these programs can be used to estimate tumor cell content and infer integer copy number of tumor subclones in a sample.

PureCN accepts CNVKit’s .cnn and .cnr files directly as input, and is recommended.

### Using CNVkit with THetA2¶

CNVkit provides wrappers for exporting .cns segments to THetA2’s input format and importing THetA2’s result file as CNVkit’s segmented .cns files. See the commands theta and import-theta for usage instructions.

After running the CNVkit Copy number calling pipeline on a sample, and calling SNVs jointly on the tumor and normal samples, generate the THetA2 input files from the .cns and .vcf files:

cnvkit.py export theta Sample_T.cns reference.cnn -v Sample_Paired.vcf


This produces three output files: Sample_T.interval_count, Sample_T.tumor.snp_formatted.txt, and Sample_T.normal.snp_formatted.txt.

Then, run THetA2 (assuming the program was unpacked at /path/to/theta2/):

# Generates Sample_T.BEST.results:
/path/to/theta2/bin/RunTHetA Sample_T.interval_count \
--TUMOR_FILE Sample_T.tumor.snp_formatted.txt \
--NORMAL_FILE Sample_T.normal.snp_formatted.txt \
--BAF --NUM_PROCESSES nproc --FORCE


Finally, import THetA2’s results back into CNVkit’s .cns format, matching the original segmentation (.cns) to the THetA2-inferred absolute copy number values.:

cnvkit.py import-theta Sample_T.cns Sample_T.BEST.results


THetA2 adjusts the segment log2 values to the inferred cellularity of each detected subclone; this can result in one or two .cns files representing subclones if more than one clonal tumor cell population was detected. THetA2 also performs some significance testing of each segment representing a CNA, so there may be fewer segments derived from THetA2 than were originally found by CNVkit.

The segment values are still log2-transformed in the resulting .cns files, for convenience in plotting etc. with CNVkit. These files are also easily converted to other formats using the export command.

## Adjusting copy ratios and segments for normal cell contamination¶

CNVkit’s call command uses an estimate of tumor fraction (from any source) to directly rescale segment log2 ratio values, and SNV b-allele frequencies if present, to the value that would be seen a completely pure, uncontaminated sample. Example with tumor purity of 60% and a male reference:

cnvkit.py call -m none Sample.cns --purity 0.6 -y -o Sample.call.cns


The call command can also convert the segmented log2 ratio estimates to absolute integer copy numbers. If the tumor cell fraction is known confidently, use the -m clonal method to round the log2 ratios to the nearest integer copy number. Alternatively, the -m threshold method to applies hard thresholds. Note that rescaling for purity is optional; either way, integer copy numbers are emitted unless the -m none option is used to skip it.

cnvkit.py call -m clonal Sample.cns -y --purity 0.65 -o Sample.call.cns
cnvkit.py call -m clonal Sample.call.cns -y -o Sample.call.cns
# With CNVkit's default cutoffs
cnvkit.py call -m threshold Sample.cns -y -o Sample.call.cns
# Or, using a custom set of cutoffs
cnvkit.py call -t=-1.1,-0.4,0.3,0.7 Sample.cns -y -o Sample.call.cns


## Export integer copy numbers as BED or VCF¶

The export bed and vcf commands emit integer copy number calls in the standard BED or VCF formats:

cnvkit.py export bed Sample.call.cns -y -o Sample.bed
cnvkit.py export vcf Sample.call.cns -y -o Sample.vcf


If the .call.cns files were generated by the call command, the integer copy numbers calculated in that step will be exported as well.