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Castle Biosciences' TissueCypher® Test Surpasses 100,000 Orders, Advancing Precision Risk Assessment for Patients with Barrett's Esophagus

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Castle Biosciences (Nasdaq:CSTL) announced that its AI-derived TissueCypher Barrett's Esophagus Test has exceeded 100,000 clinical orders as of June 16, 2026. The test is designed to predict a patient's five-year risk of progression from Barrett's esophagus to high-grade dysplasia or esophageal adenocarcinoma, helping clinicians tailor management decisions.

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AI-generated analysis. How Rhea-AI works. Not financial advice.

Positive

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Negative

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News Market Reaction – CSTL

-0.97%
-0.97% News Effect

On the day this news was published, CSTL declined 0.97%, reflecting a mild negative market reaction.

Data tracked by StockTitan Argus on the day of publication.

What This Means

This announcement highlights growing clinical adoption of TissueCypher, which has now surpassed 100,...
Analysis

This announcement highlights growing clinical adoption of TissueCypher, which has now surpassed 100,000 orders and provides individualized five-year risk estimates, such as a reported 2% progression risk for one patient case. In the past six weeks, Castle Biosciences also raised 2026 revenue guidance to $345–355M and released supportive TissueCypher data. Investors may watch future updates on test volume growth, profitability metrics like adjusted EBITDA, and additional clinical evidence for Barrett’s esophagus management.

Key Figures

TissueCypher orders: 100,000+ orders Progression risk: 2% over five years Q1 2026 revenue: $83.7M +5 more
8 metrics
TissueCypher orders 100,000+ orders Cumulative clinical test orders for Barrett’s esophagus
Progression risk 2% over five years Low-risk TissueCypher result for a Barrett’s esophagus patient
Q1 2026 revenue $83.7M Castle Biosciences Q1 2026 results
2026 revenue guidance $345–355M Raised full-year 2026 revenue guidance
Gross margin 73% Q1 2026 gross margin (adjusted 76%)
Adjusted EBITDA -$5.1M Q1 2026 adjusted EBITDA loss
Cash & investments $261.7M Balance as of March 31, 2026
DecisionDx-Melanoma reports 10,021 tests Q1 2026 core test volume

Historical Context

5 past events · Latest: May 13 (Positive)
Pattern 5 events
Date Event Sentiment 24h Move Catalyst
May 13 Conference presentation Positive -2.6% Jefferies Global Healthcare Conference presentation announcement with webcast access.
May 12 Industry award Positive -2.1% AdvanceAD-Tx test received a 2026 MedTech Breakthrough genomics innovation award.
May 06 Q1 2026 earnings Positive -22.3% Q1 revenue reported at $83.7M with raised full-year 2026 revenue guidance.
May 05 Advocacy initiatives Positive -3.6% Support for nationwide skin cancer advocacy, screenings and education activities in May.
May 04 Clinical data update Positive +2.9% Mayo Clinic DDW 2026 data showing TissueCypher improves Barrett’s esophagus risk stratification.

24h Move is the share-price change in the day after each event; other market factors may also have contributed.

Pattern Detected

Recent positive or neutral announcements have often seen negative price reactions, with only the latest TissueCypher clinical data drawing a modestly positive move.

Recent Company History

Over the last few months, Castle Biosciences reported several developments. An earnings release on May 6, 2026 showed Q1 revenue of $83.7M and raised 2026 guidance, yet shares fell sharply. Earlier May news on advocacy initiatives and an industry award also coincided with modest declines. In contrast, new TissueCypher data presented at DDW 2026 on May 4 prompted a small gain. Today’s announcement that TissueCypher has surpassed 100,000 orders extends that product-focused momentum but follows a pattern of muted or adverse reactions to generally constructive news.

Regulatory & Risk Context

Short Interest: 5.26%
Short Interest
5.26% of float
0% 15% 30%+
low as of 2026-05-29 Days to cover: 3.78

Key Terms

barrett's esophagus, esophageal adenocarcinoma, endoscopic eradication therapy
3 terms
barrett's esophagus medical
"TissueCypher is an AI-derived precision medicine test designed to predict a patient's five-year risk of progression from Barrett's esophagus (BE)..."
A condition where the cells lining the lower esophagus change after repeated acid injury from stomach reflux, creating tissue that looks and behaves differently than normal. It matters to investors because this change raises the long-term risk of esophageal cancer and therefore drives demand for diagnostic tests, monitoring programs, medical procedures and drug development; like spotting damaged wallpaper that signals the need for repairs, its detection can affect healthcare costs and market opportunities.
esophageal adenocarcinoma medical
"Barrett's esophagus (BE) is the only known precursor to esophageal adenocarcinoma (EAC), a gastrointestinal cancer..."
Esophageal adenocarcinoma is a form of cancer that begins in the gland-like cells lining the lower part of the esophagus, the tube that carries food to the stomach. It matters to investors because it is often aggressive and has limited treatment options, so advances, trial results, regulatory approvals, or changes in insurance coverage for new tests and therapies can materially affect the prospects and valuations of companies working on diagnostics, drugs, or procedures—like a bridge repair changing traffic for nearby businesses.
endoscopic eradication therapy medical
"...including consideration of intensified surveillance or endoscopic eradication therapy for high-risk patients..."
Endoscopic eradication therapy is a group of minimally invasive procedures that use a flexible tube with a camera to locate and remove or destroy abnormal tissue lining the digestive tract, often to stop precancerous changes from progressing. For investors, it signals markets for specialized medical devices, procedure revenues and reimbursement trends, and clinical outcomes that can affect adoption—think of it as removing embers before a small fire becomes catastrophic.

AI-generated analysis. How Rhea-AI works. Not financial advice.

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FRIENDSWOOD, Texas, June 16, 2026 /PRNewswire/ -- Castle Biosciences, Inc. (Nasdaq: CSTL), a company improving health through innovative tests that guide patient care, today announced that its TissueCypher® Barrett's Esophagus Test has surpassed 100,000 clinical test orders. TissueCypher is an AI-derived precision medicine test designed to predict a patient's five-year risk of progression from Barrett's esophagus (BE) to high-grade dysplasia or esophageal adenocarcinoma.

"Barrett's esophagus (BE) is the only known precursor to esophageal adenocarcinoma (EAC), a gastrointestinal cancer associated with poor survival outcomes," said Emmanuel Gorospe, M.D., MPH, FACG, FASGE, board-certified gastroenterologist and medical director at Castle Biosciences.1,2 "TissueCypher provides clinically validated risk stratification for patients with BE by identifying those at increased risk of progression to high-grade dysplasia or EAC. It can help clinicians tailor management decisions based on an individual patient's risk profile, including consideration of intensified surveillance or endoscopic eradication therapy for high-risk patients and appropriate routine surveillance for low-risk patients."

"Reaching 100,000 orders reflects the growing use of TissueCypher to provide patients with more personalized information about their risk of progression," said Toby Juvenal, chief commercial officer of Castle Biosciences. "We are grateful to the clinicians who have incorporated TissueCypher into the management of patients with Barrett's esophagus and to the patients who continue to advocate for more informed approaches to their care."

For some patients, understanding their risk of progression may help reduce uncertainty after diagnosis. Robin Byrd Wilfong, a patient diagnosed with BE, received a low-risk TissueCypher result indicating a 2% chance of progression over five years. "I don't feel like a ticking time bomb," she said. "I feel like I've got time to manage this the way I choose."

To learn more about Robin's experience with TissueCypher, watch her story here.

Castle Biosciences

About TissueCypher Barrett's Esophagus Test
TissueCypher is a precision medicine test designed and extensively validated to predict a patient's personalized risk of progression from Barrett's esophagus (BE) to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). Indicated for patients with non-dysplastic BE, indefinite for dysplasia or with low-grade dysplasia, TissueCypher's five-year risk assessment is designed to help physicians tailor care to each patient's risk of developing HGD or EAC.

Backed by more than 17 peer-reviewed publications and studied in biopsies from more than 8,000 patients, TissueCypher has been shown to be the strongest independent predictor of progression compared with traditional histopathological risk assessment. Using an AI-derived spatialomics approach, the test identifies molecular signatures that often precede the development of dysplasia, which can enable earlier identification, treatment, and management of patients at increased risk of cancer. TissueCypher is designed to integrate seamlessly into routine endoscopic practice by analyzing standard esophageal pinch biopsies, delivering actionable insights without requiring additional procedures. Learn more at CastleBiosciences.com/TissueCypher.

About Castle Biosciences 
Castle Biosciences (Nasdaq: CSTL) is a leading diagnostics company improving health through innovative tests that guide patient care. With a primary focus in dermatologic and gastroenterological disease, we develop personalized, clinically actionable solutions that help improve disease management and patient outcomes. 

We put people first—empowering patients and clinicians and informing care decisions through rigorous science and advanced molecular tests that support more confident treatment planning. To learn more, visit www.CastleBiosciences.com and connect with us on LinkedIn, Instagram, Facebook and X.

DecisionDx-Melanoma, DecisionDx-CMSeq, i31-SLNB, i31-ROR, DecisionDx-SCC, MyPath Melanoma, AdvanceAD-Tx, TissueCypher, Esopredict, DecisionDx-UM, DecisionDx-PRAME and DecisionDx-UMSeq are trademarks of Castle Biosciences, Inc.

Forward-Looking Statements
This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, which are subject to the "safe harbor" created by those sections. These forward-looking statements include, but are not limited to, statements concerning: TissueCypher's ability to (i) predict a patient's personalized risk of progression from Barrett's esophagus to high-grade dysplasia or esophageal adenocarcinoma, (ii) help clinicians tailor surveillance and management decisions to each patient's individual risk profile, (iii) enable earlier identification and management of patients at increased risk of cancer, and (iv) help reduce uncertainty for patients. The words "believe," "can," "may" and similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. We may not actually achieve the plans, intentions or expectations disclosed in our forward-looking statements, and you should not place undue reliance on our forward-looking statements. Actual results or events could differ materially from the plans, intentions and expectations disclosed in the forward-looking statements that we make. These forward-looking statements involve risks and uncertainties that could cause our actual results to differ materially from those in the forward-looking statements, including, without limitation: subsequent study or trial results and findings may contradict earlier study or trial results and findings or may not support the results obtained in these studies, including with respect to the discussion of our tests in this press release; actual application of our tests may not provide the aforementioned benefits to patients; and the risks set forth under the heading "Risk Factors" in our Annual Report on Form 10-K for the year ended December 31, 2025, and our subsequent Quarterly Reports on Form 10-Q, each as filed or to be filed with the SEC, and in our other filings with the SEC. The forward-looking statements are applicable only as of the date on which they are made, and we do not assume any obligation to update any forward-looking statements, except as may be required by law.

  1. Katzka DA, Spechler SJ, Fitzgerald RC, et al. AGA clinical practice update on new technology and innovation for surveillance and screening in Barrett's esophagus: expert review. Gastroenterology. Published online April 23, 2025. doi:10.1053/j.gastro.2025.04.021
  2. World Cancer Research Fund International. Less survivable cancers and what can be done about them. Published January 3, 2023. Accessed May 20, 2026. https://www.wcrf.org/less-survivable-cancers/

Investor Contact:
Camilla Zuckero
czuckero@castlebiosciences.com

Media Contact:
Allison Marshall
amarshall@castlebiosciences.com

Castle Biosciences celebrates 100,000 clinical orders for its TissueCypher® Barrett's Esophagus Test.

Cision View original content to download multimedia:https://www.prnewswire.com/news-releases/castle-biosciences-tissuecypher-test-surpasses-100-000-orders-advancing-precision-risk-assessment-for-patients-with-barretts-esophagus-302800654.html

SOURCE Castle Biosciences, Inc.

FAQ

What milestone did Castle Biosciences (CSTL) announce for the TissueCypher test in June 2026?

Castle Biosciences reported that TissueCypher has surpassed 100,000 clinical test orders. According to Castle Biosciences, this reflects growing clinical use of the AI-derived precision medicine test for patients with Barrett's esophagus, supporting more personalized risk assessment of progression.

What does the TissueCypher Barrett's Esophagus Test from Castle Biosciences (CSTL) measure?

TissueCypher is designed to predict a patient's five-year risk of progression from Barrett's esophagus to high-grade dysplasia or esophageal adenocarcinoma. According to Castle Biosciences, the test provides clinically validated risk stratification that can inform individualized surveillance and treatment decisions.

How can TissueCypher test results influence treatment decisions for Barrett's esophagus patients?

TissueCypher results can help clinicians tailor management based on individual risk profiles. According to Castle Biosciences, high-risk patients may be considered for intensified surveillance or endoscopic eradication therapy, while low-risk patients may continue with appropriate routine surveillance strategies.

What patient experience was shared regarding Castle Biosciences' TissueCypher test?

Castle Biosciences highlighted a patient, Robin Byrd Wilfong, who received a low-risk TissueCypher result indicating a 2% five-year progression chance. According to Castle Biosciences, this information helped her feel less uncertainty and more control over how she manages Barrett's esophagus.

Why is Barrett's esophagus risk assessment important for Castle Biosciences (CSTL) TissueCypher users?

Barrett's esophagus is described as the only known precursor to esophageal adenocarcinoma, a cancer with poor survival outcomes. According to Castle Biosciences, TissueCypher offers clinically validated risk stratification to identify patients at increased progression risk and support more informed care decisions.

How is TissueCypher described as a precision medicine tool by Castle Biosciences (CSTL)?

TissueCypher is described as an AI-derived precision medicine test for Barrett's esophagus. According to Castle Biosciences, the test provides individualized, clinically validated risk information that can support more personalized surveillance and treatment planning across different patient risk categories.