Journal of bronchology & interventional pulmonology · 2025
Proceduralist-Directed Rapid On-Site Pathologic Evaluation (ROPE) Using Dynamic Cell Imaging: A Pilot Study of Peripheral Pulmonary Lesion Sampling Through Robotic Bronchoscopy.
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Matus Ismael, Akhtar Sameer, Raja Haroon, Holmes Phoebe
Аннотация
BACKGROUND: Diagnostic evaluation of peripheral pulmonary lesions (PPLs) relies on complementary technologies. Rapid onsite evaluation (ROSE) of cytopathology's role is established for mediastinal lymph nodes, though less studied for PPLs. VanGogh, a novel Dynamic Cell Imaging (DCI) technology for on-site histopathologic analysis ( formerly CelTivity, used in the study) may offer intraprocedural confirmation of diagnostic tissue during the evaluation of PPLs. This study looks to quantify the concordance between rapid onsite pathologic evaluation (ROPE) under DCI and a pathologist's diagnosis in evaluating PPLs.
METHODS: Single-center study of robotic bronchoscopic PPL samples using 21G fine needle aspiration, cryobiopsy, and forceps biopsy. Samples interpreted at the point of care by the proceduralist using DCI as either lesional or nonlesional, then evaluated by a pathologist as either diagnostic or nondiagnostic. The concordance between the proceduralist's and the pathologist's assessments was calculated at the patient-level and biopsy-level and stratified by tissue acquisition technique.
RESULTS: Fifty patients with 146 samples were included. Overall concordance between the proceduralist's DCI interpretation and the pathologist's diagnosis was 88% (95% CI: not defined) at the patient level. Overall concordance was 84% (95% CI: 77%-90%). Stratified by tissue acquisition technique, concordance was highest for cryobiopsy (88% [95% CI: not defined]) and forceps biopsy (86% [95% CI: 74-94]).
CONCLUSION: ROPE, using cryoprobe and forceps biopsy of PPLs, demonstrated high concordance with final pathology, improving intraprocedural confidence in procuring representative diagnostic specimens. Further studies may determine DCI's impact on diagnostic yields and confirmatory role in target localization for future bronchoscopy ablative treatments.
METHODS: Single-center study of robotic bronchoscopic PPL samples using 21G fine needle aspiration, cryobiopsy, and forceps biopsy. Samples interpreted at the point of care by the proceduralist using DCI as either lesional or nonlesional, then evaluated by a pathologist as either diagnostic or nondiagnostic. The concordance between the proceduralist's and the pathologist's assessments was calculated at the patient-level and biopsy-level and stratified by tissue acquisition technique.
RESULTS: Fifty patients with 146 samples were included. Overall concordance between the proceduralist's DCI interpretation and the pathologist's diagnosis was 88% (95% CI: not defined) at the patient level. Overall concordance was 84% (95% CI: 77%-90%). Stratified by tissue acquisition technique, concordance was highest for cryobiopsy (88% [95% CI: not defined]) and forceps biopsy (86% [95% CI: 74-94]).
CONCLUSION: ROPE, using cryoprobe and forceps biopsy of PPLs, demonstrated high concordance with final pathology, improving intraprocedural confidence in procuring representative diagnostic specimens. Further studies may determine DCI's impact on diagnostic yields and confirmatory role in target localization for future bronchoscopy ablative treatments.