Use of the Vangogh System to Assess for Intra-operative Tissue Adequacy: Initial Experience

Abstract

Abstract Rationale As targeted cancer therapies continue to evolve, tissue sampling adequacy for both initial diagnosis and molecular markers is paramount. However, lung biopsy confers increasing risk as additional samples are obtained. Current practice involves the use of rapid on-site evaluation (ROSE) of biopsy samples, though this process is inherently limited as only a fraction of cells from the sample are available for preparation and assessment. Dynamic cell imaging (DCI) is an emerging technique which may provide a rapid, real-time histological assessment of the unprocessed fresh tissue for cellularity, morphology and metabolic activity; furthermore, this technique preserves tissue specimens for molecular testing, enhances intracellular contrast, assesses the entirety of the sample, and adapts to machine learning approaches to allow for a reproducible and consistent result. We aim to discuss our center's experience implementing this technology via a review of the initial patient cases utilizing DCI during lung biopsy. Methods Peripheral biopsies from 51 patients were evaluated using the VanGogh system between March and September of 2024. Total case count was limited by device availability due to an institutional loan agreement with the device representatives. All biopsies were sampled using the same robotic bronchoscope and superDimension forceps. No cryobiopsies were obtained. The first peripheral biopsy was made into a touch prep, then the entirety of the sample was placed on the VanGogh plate and scanned per protocol. Due to scanning times, the fourth biopsy if performed was also scanned. All biopsy material was then returned and assessed on final pathology. Results Of the 51 biopsies performed, 24 demonstrated malignancy on final pathology. The 27 non-cancerous lesions were composed of infections and granulomatous inflammation that resolved upon follow up. One neuroendocrine malignant case was identified, and molecular testing was not performed. VanGogh assessed the remaining 23 malignant cases for metabolic activity and number of cells, determining adequate lesional material. Of the 23 malignant biopsy samples, 100% had adequate tissue for molecular profiling. Conclusion DCI has recently been applied in several tissue types for evaluation of adequacy of pathologic specimens and assessment of malignancy by capturing cellular metabolic activity and morphology. Among cancer cases, DCI was able to determine adequacy for molecular assessment in 100% of our patients, as later confirmed via formal pathology assessment. DCI may potentially improve the institutional efficiency of lung biopsy.