Abstract. Background/Aim: Development of patient-derived three-dimensional (3D) organoid cultures is an emerging technique in the field of precision oncology. We aimed to integrate on-site adequacy evaluation using cytology into the tumor organoid development workflow to ensure precise characterization and growth of these cultures. Patients andPersonalized medicine, also referred to as Precision Medicine (PM), is the approach to treat a patient's disease by taking into account the molecular landscape of the individual tumor or disease process. In addition to its role in oncology, PM is also employed in the treatment of other chronic conditions such as autoimmune disorders. In the United States, the Precision Medicine Initiative ® was launched by President Barack Obama in early 2015 in order to facilitate individualized patient care. Recently, the National Institute of Health (NIH) awarded $55 million to enroll one million patients in a multi-institutional precision medicine trial (1).In the field of Precision Oncology, the development of patient-derived 3D tumor organoid cultures is an emerging model that can be a valuable tool for predictive in vitro drug testing (2). Although cell lines have long been established for preclinical drug testing, they do not sufficiently recapitulate the innate tumor heterogeneity and therefore the genomic complexity. Organoid cultures are thus the preferable method for predictive drug testing (3). Organoids are derived from stem cells and are self-organizing and selfrenewing (4). Since organoids maintain the genetic representation of a patient's tumor, they are a readily available source of high-quality DNA and RNA for next generation sequencing (NGS). In order to initiate organoid development, fresh tumor tissue is collected and processed
1569This article is freely accessible online. Organoid development is a time-and cost-intense process. As yet, no cost estimate per organoid development has been published. Organoids are usually propagated in Matrigel Matrix (Corning Inc. USA), which closely resembles extracellular matrix. It provides a scaffold for cells to grow and proliferate (7). Matrigel is a relatively expensive medium priced at approximately $318 per bottle. Costs for technical staff adds to the expenditure for cell culture infrastructure and consumables. Submitting tissue for organoid development "blindly", i.e. without prior characterization, can result in spending money and time propagating benign organoids. Submitting only lesional tissue for further processing is therefore paramount. Rapid on-site evaluation (ROSE) is a common practice in cytopathology that assesses tissue samples for adequacy of material for diagnostic purposes. We have recently shown, that cytological evaluation of organoids within a few weeks into their development can successfully characterize them (8). In the present study, we aimed to integrate on-site cytological evaluation during tissue collection to identify viable tumor for organoid development and guide decision-making on the early fate ...