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Robotic MRI/CT Guided Multiregional 'smart' Biopsy for Characterization of Tumor Heterogeneity: A Prospective
Edward W Johnston1, Jessica M Winfield2, Amani Arthur3
1Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London SW36JJ, United Kingdom (E.W.J., J.B., N.F.); Division of Radiotherapy and Imaging, Institute of Cancer Research, 15 Cotswold Rd, Sutton SM2 5NG, United Kingdom (E.W.J., J.M.W., A.A., M.B., J.H., A.H., M.S., D-M.K., C.M., N.F.).
Rationale And Objectives:
Intratumoral heterogeneity means single site tumor biopsy might not be representative. Here we develop and optimize an MRI-informed robotic multiregional 'smart' biopsy technique in retroperitoneal and pelvic sarcomas (RPS). We also explore the relationship between imaging and histological biomarkers.
Materials And Methods:
Participants with suspected RPS underwent multiparametric (mp)MRI within a week prior to biopsy. Three target regions with differing MRI characteristics were contoured. Robotic or freehand multiregional biopsy was performed, collecting samples from each target region in separate specimen pots. CT/MRI fusion extracted quantitative imaging biomarkers for correlation with histological biomarkers at precise biopsy sites. The primary endpoint was feasibility and safety. Spearman's correlation explored the relationship between imaging and histological biomarkers.
Results:
Twelve participants (7 women), median age 58.6 years interquartile range [IQR]: 52 - 75 years underwent biopsy. All procedures were technically successful with same-day discharge. The within-tumor range of Apparent Diffusion Coefficeint correlated very strongly with the within-tumor range of Ki-67 proliferation index; Spearman's ρ = 0.91 (95% CI 0.68 to 0.98). Ranges represent intratumoral heterogeneity uniquely obtained by multiregional biopsy.
Conclusion:
Multiregional robotic MRI-informed, CT-guided biopsy is feasible and safe in RPS. Sampling three distinct regions within tumors provides a more comprehensive and accurate representation of tumor biology than standard biopsy. The close relationship between imaging and histological heterogeneity biomarkers has broader implications for pancancer biopsy techniques, imaging characterization, and personalized treatment selection.
Insights
Multiregional robotic biopsy using MRI guidance is a safe and feasible technique for retroperitoneal and pelvic sarcomas. This approach captures tumor heterogeneity, offering a more accurate representation of tumor biology than standard biopsies.
Area of Science:
- Oncology
- Radiology
- Surgical Oncology
Background:
- Intratumoral heterogeneity poses challenges for single-site tumor biopsies.
- Accurate tumor characterization is crucial for personalized treatment.
Purpose of the Study:
- To develop and optimize an MRI-informed robotic multiregional biopsy technique for retroperitoneal and pelvic sarcomas (RPS).
- To explore the correlation between imaging and histological biomarkers within tumors.
Main Methods:
- Participants with suspected RPS underwent multiparametric MRI before biopsy.
- Robotic or freehand multiregional biopsies targeted regions with distinct MRI characteristics.
- CT/MRI fusion quantified imaging biomarkers for correlation with histological biomarkers.
Main Results:
- Twelve participants underwent technically successful biopsies with same-day discharge.
- A strong correlation was observed between the range of Apparent Diffusion Coefficient and the Ki-67 proliferation index (Spearman's ρ = 0.91).
- Multiregional sampling uniquely captured intratumoral heterogeneity.
Conclusions:
- Multiregional robotic MRI-informed biopsy is feasible and safe for RPS.
- Sampling distinct tumor regions provides a comprehensive representation of tumor biology.
- The correlation between imaging and histological heterogeneity has implications for pancancer biopsy and personalized medicine.
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