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Combination of Hand-Held Probe and Microscopy for Fluorescence Guided Surgery in the Brain Tumor Marginal Zone

Richter, Johan (author)
Linköpings universitet,Östergötlands Läns Landsting,Neurokirurgiska kliniken US,Biomedicinsk instrumentteknik,Tekniska fakulteten,MINT
Haj Hosseini, Neda (author)
Linköpings universitet,Biomedicinsk instrumentteknik,Tekniska fakulteten,MINT
Hallbeck, Martin, 1970- (author)
Linköpings universitet,Avdelning för neurobiologi,Medicinska fakulteten,Region Östergötland, Klinisk patologi
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Wårdell, Karin, 1959- (author)
Linköpings universitet,Avdelningen för medicinsk teknik,Tekniska fakulteten,MINT
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 (creator_code:org_t)
Amsterdam : Elsevier, 2017
2017
English.
In: Photodiagnosis and Photodynamic Therapy. - Amsterdam : Elsevier. - 1572-1000. ; 18, s. 185-192
  • Journal article (peer-reviewed)
Abstract Subject headings
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  • BackgroundVisualization 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 MethodsEighteen 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.ResultsFluorescence 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.ConclusionsThe 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.

Subject headings

TEKNIK OCH TEKNOLOGIER  -- Medicinteknik (hsv//swe)
ENGINEERING AND TECHNOLOGY  -- Medical Engineering (hsv//eng)

Keyword

High-grade glioma
Fluorescence guided resection (FGR)
5-Aminolaevulinic acid (5-ALA)
Fluorescence spectroscopy
Protoporphyrin (PpIX)

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art (subject category)

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