Johan C O Richter1, Neda Haj-Hosseini2, Martin Hallbeck3, Karin Wårdell2. 1. Department of Biomedical Engineering, Linköping University, Sweden; Department of Neurosurgery Linköping University Hospital, Region Östergötland, Linköping, Sweden. Electronic address: johan.richter@regionostergotland.se. 2. Department of Biomedical Engineering, Linköping University, Sweden. 3. Department of Clinical Pathology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Abstract
BACKGROUND: Visualization of the tumor is crucial for differentiating malignant tissue from healthy brain during surgery, especially in the tumor marginal zone. The aim of the study was to introduce a fluorescence spectroscopy-based hand-held probe (HHF-probe) for tumor identification in combination with the fluorescence guided resection surgical microscope (FGR-microscope), and evaluate them in terms of diagnostic performance and practical aspects of fluorescence detection. MATERIAL AND METHODS: Eighteen operations were performed on 16 patients with suspected high-grade glioma. The HHF-probe and the FGR-microscope were used for detection of protoporphyrin (PpIX) fluorescence induced by 5-aminolevulinic acid (5-ALA) and evaluated against histopathological analysis and visual grading done through the FGR-microscope by the surgeon. A ratio of PpIX fluorescence intensity to the autofluorescence intensity (fluorescence ratio) was used to quantify the spectra detected by the probe. RESULTS: Fluorescence ratio medians (range 0 - 40) measured by the probe were related to the intensity of the fluorescence in the FGR-microscope, categorized as "none" (0.3, n=131), "weak" (1.6, n=34) and "strong" (5.4, n=28). Of 131 "none" points in the FGR-microscope, 88 (67%) exhibited fluorescence with the HHF-probe. For the tumor marginal zone, the area under the receiver operator characteristics (ROC) curve was 0.49 for the FGR-microscope and 0.65 for the HHF-probe. CONCLUSIONS: The probe was integrated in the established routine of tumor resection using the FGR-microscope. The HHF-probe was superior to the FGR-microscope in sensitivity; it detected tumor remnants after debulking under the FGR-microscope. The combination of the HHF-probe and the FGR-microscope was beneficial especially in the tumor marginal zone.
BACKGROUND: Visualization of the tumor is crucial for differentiating malignant tissue from healthy brain during surgery, especially in the tumor marginal zone. The aim of the study was to introduce a fluorescence spectroscopy-based hand-held probe (HHF-probe) for tumor identification in combination with the fluorescence guided resection surgical microscope (FGR-microscope), and evaluate them in terms of diagnostic performance and practical aspects of fluorescence detection. MATERIAL AND METHODS: Eighteen operations were performed on 16 patients with suspected high-grade glioma. The HHF-probe and the FGR-microscope were used for detection of protoporphyrin (PpIX) fluorescence induced by 5-aminolevulinic acid (5-ALA) and evaluated against histopathological analysis and visual grading done through the FGR-microscope by the surgeon. A ratio of PpIX fluorescence intensity to the autofluorescence intensity (fluorescence ratio) was used to quantify the spectra detected by the probe. RESULTS: Fluorescence ratio medians (range 0 - 40) measured by the probe were related to the intensity of the fluorescence in the FGR-microscope, categorized as "none" (0.3, n=131), "weak" (1.6, n=34) and "strong" (5.4, n=28). Of 131 "none" points in the FGR-microscope, 88 (67%) exhibited fluorescence with the HHF-probe. For the tumor marginal zone, the area under the receiver operator characteristics (ROC) curve was 0.49 for the FGR-microscope and 0.65 for the HHF-probe. CONCLUSIONS: The probe was integrated in the established routine of tumor resection using the FGR-microscope. The HHF-probe was superior to the FGR-microscope in sensitivity; it detected tumor remnants after debulking under the FGR-microscope. The combination of the HHF-probe and the FGR-microscope was beneficial especially in the tumor marginal zone.
Authors: David Black; Horst K Hahn; Ron Kikinis; Karin Wårdell; Neda Haj-Hosseini Journal: Int J Comput Assist Radiol Surg Date: 2017-09-19 Impact factor: 2.924
Authors: Neda Haj-Hosseini; Johan C O Richter; Peter Milos; Martin Hallbeck; Karin Wårdell Journal: Biomed Opt Express Date: 2018-04-20 Impact factor: 3.732
Authors: Evgenii Belykh; Eric J Miller; Arpan A Patel; Baran Bozkurt; Kaan Yağmurlu; Timothy R Robinson; Peter Nakaji; Robert F Spetzler; Michael T Lawton; Leonard Y Nelson; Eric J Seibel; Mark C Preul Journal: Sci Rep Date: 2018-08-22 Impact factor: 4.379
Authors: Michael Reinert; Deborah Piffaretti; Marco Wilzbach; Christian Hauger; Roland Guckler; Francesco Marchi; Maria Luisa D'Angelo Journal: Front Surg Date: 2019-07-16