A comprehensive benchmark of transcriptome-wide fusion detection using long-read RNA sequencing

Fusion transcripts contribute to cancer, inherited diseases, developmental disorders, and evolution. Long-read RNA sequencing enables direct sequencing of full-length transcripts, creating new opportunities to detect complex fusion architectures, including previously inaccessible multi-segmented fusion transcripts. However, accurate transcriptome-wide fusion detection remains challenging because existing methods struggle to distinguish genuine fusion events from technical artefacts. Here, we present a comprehensive benchmark of transcriptome-wide fusion detection using simulated datasets and transcriptomes from three cancer cell lines across Oxford Nanopore Technologies (ONT) cDNA, PCR-cDNA, and direct RNA sequencing, Pacific Biosciences (PacBio) Kinnex sequencing, Illumina short-read RNA sequencing, six long-read fusion callers, and multiple analysis strategies. False-positive fusion calls remained the dominant limitation across sequencing platforms and algorithms. Increasing sequencing depth improved recall but also amplified spurious fusion calls, whereas higher read-support thresholds improved precision at the expense of sensitivity. ONT PCR-cDNA sequencing combined with CTAT-LR-Fusion achieved the best overall balance between precision and recall, whereas JAFFAL was the only caller to reliably identify simulated tri-gene fusions. Consensus calling reduced false positives but markedly reduced sensitivity, with only one of 400 simulated fusions detected by all six callers. Breakpoint localisation emerged as a major limitation across all methods. Long-read sequencing consistently recovered more validated fusion transcripts than short-read sequencing, enabled detection of complex tri-gene fusions, and produced more biologically plausible fusion landscapes with fewer promiscuous gene partners. Collectively, our results establish the first comprehensive benchmarking framework for transcriptome-wide fusion detection, using long-read RNA sequencing, and provide practical guidance for selecting sequencing workflows and computational strategies, while identifying key priorities for future algorithm development.