The Evaluation of a Tissue Sample Utilizing the CelTivity Biopsy System During a Robotic Navigational Bronchoscopy; a Case Review.
Author: Wilson Tsai, MD / John Muir Health, Concord Medical Center
Case Presentation: A 66-year-old female referred for evaluation and treatment of a 1.8 cm lung nodule in the Right Lower Lobe. The patient had been enrolled in the Lung Cancer Screening program and reported experiencing no current or past pulmonary symptoms. She denied dyspnea, chest pain, hemoptysis, or cough. She was able to ambulate without dyspnea. She is a current smoker with a 40-pack year smoking history and has had no known exposure to tuberculosis. The patient did not have a history of cancer.
Management and Outcomes: Patient underwent a Robotic Navigational Bronchoscopy with a forceps biopsy of the nodule. On first pass with the forceps, the tissue was submitted for evaluation with the CelTivity™ Biopsy System and a second specimen was submitted to the pathologist for ROSE (rapid on-site evaluation). Within 11 seconds, CelTivity had displayed an image capturing pleomorphic cells with high level of cellular activity (fig. 1) which is consistent with malignancy. Several minutes later, the pathologist confirmed the diagnosis after evaluating the slides with the standard staining protocol.
The patient immediately underwent a Robotic Assisted Right Thoracoscopy; a complete mediastinal lymphadenectomy to evaluate for N2 disease. No lymph nodes showed malignancy on frozen specimen and the patient further underwent a completion lobectomy for curative intent. Final pathology confirmed the nodule was adenocarcinoma (fig. 2). This was consistent with the intraprocedural assessment from CelTivity and ROSE.
Discussion: The CelTivity Biopsy System displays microscopic images that highlight areas of increased intracellular activity which help identify abnormal cells such as cancer, immune cells, and others. This case report demonstrates that CelTivity offers an efficient and accurate method for intraprocedural adequacy assessment of pulmonary biopsies. By immediately confirming or increasing the suspicion of malignancy, physicians may further guide their patients’ treatment without the delay in waiting for results from permanent specimens. This case study provides further evidence that the CelTivity technology can rapidly and accurately assess entire biopsy samples with or without the utilization of ROSE.
Figure 1: A CelTivity™ Dynamic Cell Image which captures cellular activity
represented by the high contrasted cellular areas representative of cancer cells.
Figure 2: Final pathology image confirming adenocarcinoma. Consistent
with intraprocedural tissue assessment.
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