CIO 2021-12 Virtual Biopsy Utility in the Management of Oncologic Patients: Applications and Future Directions

Purpose: Virtual biopsy is a non-invasive alternative for the surveillance and management of a variety of cancers. We describe the techniques of virtual biopsy and its applications in cancer screening, diagnosis, staging, and prognostication. We further highlight the opportunities and challenges of virtual biopsy and its role in contemporary oncology practice.

Material and Methods: In this educational exhibit, a comprehensive literature review was conducted researching the applications of virtual biopsy and its effect on clinical outcomes. The literature search was conducted via PubMed and Google Scholar.

Results: A great wealth of generally-qualitative information can be obtained through standard interpretation of imaging; however, a large amount of encrypted data still remains invisible to the human eye. These higher-level imaging-characteristics provide information regarding a tissue’s intrinsic features, gene expression patterns, gene mutations, and molecular pathophysiology. With the emergence of radiomics and radiogenomics, virtual biopsy is able to improve clinical outcomes by increasing precision in cancer screening, as demonstrated in lung and pancreatic cancer screening for high-risk populations. Additionally, virtual biopsy is further able to diagnose and stage tumors, as seen with head and neck squamous cell carcinoma, gliomas, and invasive ductal carcinomas, without invasive tissue sampling and associated risk, recovery, and cost. Data yielded from virtual biopsy can further predict the prognosis of a variety of cancers including transitional cell carcinoma of the bladder, pancreatic ductal adenocarcinoma, and breast cancer. Moreover, unique tissue characteristics revealed by virtual biopsy can lead to more tailored treatment plans, as has been demonstrated with identification of treatment-sensitive mutations in patients with glioblastoma. Lastly, by revealing tumor heterogeneity, virtual biopsy can improve tissue targeting, allowing for more accurate image-guided and surgical biopsies. Some limitations include increased computing power and storage requirements, and lack of standardization of acquisition parameters, affecting the reproducibility of the data.

Conclusions: Virtual biopsy is a promising non-invasive cohort of imaging techniques with the potential for examining of tissue for non-invasive diagnosis, screening, prognostication, and treatment planning, as well as improved surgical biopsy.