Clinical guidelines for the use of intraoperative fluorescence diagnosis in brain tumor surgery

Потапов, А А; Sa, Goryaynov; Va, Okhlopkov; Di, Pitskhelauri; Gl, Kobyakov; Vy, Zhukov; Da, Gol'bin; Dv, Svistov; Bv, Martynov; Al, Krivoshapkin; Gaitán, Armando; Ye, Anokhina; Varyukhina,; Mf, Goldberg; Av, Kondrashov; Ap, Chumakova

doi:10.17116/neiro201579591-101

Cited by 19 publications

(11 citation statements)

References 69 publications

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“…Most studies on glioma surgery with 5-ALA fluorescence for guidance have documented increases in tumor resection area ( 109 , 110 ). The results of a phase III study indicated a 1.5-month increase in progression-free survival with 5-ALA fluorescence-guided surgery ( 111 ).…”

Section: Fluorescent Dyes In Neurosurgerymentioning

confidence: 99%

Intraoperative Fluorescence Imaging for Personalized Brain Tumor Resection: Current State and Future Directions

et al. 2016

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IntroductionFluorescence-guided surgery is one of the rapidly emerging methods of surgical “theranostics.” In this review, we summarize current fluorescence techniques used in neurosurgical practice for brain tumor patients as well as future applications of recent laboratory and translational studies.MethodsReview of the literature.ResultsA wide spectrum of fluorophores that have been tested for brain surgery is reviewed. Beginning with a fluorescein sodium application in 1948 by Moore, fluorescence-guided brain tumor surgery is either routinely applied in some centers or is under active study in clinical trials. Besides the trinity of commonly used drugs (fluorescein sodium, 5-aminolevulinic acid, and indocyanine green), less studied fluorescent stains, such as tetracyclines, cancer-selective alkylphosphocholine analogs, cresyl violet, acridine orange, and acriflavine, can be used for rapid tumor detection and pathological tissue examination. Other emerging agents, such as activity-based probes and targeted molecular probes that can provide biomolecular specificity for surgical visualization and treatment, are reviewed. Furthermore, we review available engineering and optical solutions for fluorescent surgical visualization. Instruments for fluorescent-guided surgery are divided into wide-field imaging systems and hand-held probes. Recent advancements in quantitative fluorescence-guided surgery are discussed.ConclusionWe are standing on the threshold of the era of marker-assisted tumor management. Innovations in the fields of surgical optics, computer image analysis, and molecular bioengineering are advancing fluorescence-guided tumor resection paradigms, leading to cell-level approaches to visualization and resection of brain tumors.

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Section: Fluorescent Dyes In Neurosurgerymentioning

confidence: 99%

Intraoperative Fluorescence Imaging for Personalized Brain Tumor Resection: Current State and Future Directions

et al. 2016

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“…Presently, various intraoperative technologies (ultrasound, magnetic resonance imaging, fluorescence imaging) are commonly used in surgical treatment of gliomas; these techniques are aimed at improving safety and radicality of the tumor removal [1][2][3][4]. Recent studies demonstrated that the volume of tumor resection significantly correlates with life expectancy of patients in this group [5][6][7][8].…”

Section: сLinical Medicinementioning

confidence: 99%

Cross-Polarization Optical Coherence Tomography in Comparative in vivo and ex vivo Studies of the Optical Properties of Normal and Tumorous Brain Tissues

Kiseleva¹,

Yashin²,

Моисеев³

et al. 2017

Sovrem Tehnol Med

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The aim of the study was to provide visual and quantitative evaluation of normal and tumorous brain tissue images obtained by crosspolarization optical coherence tomography (CP OCT) in comparative in vivo and ex vivo studies.Materials and Methods. The study was conducted using CP OCT -a non-damaging optical method of tissue structure imaging, which is capable of obtaining real time 3D images 2.4×2.4×1.25 mm in size within a short time of 26 s. The object of the study were normal and tumorous brain tissues of 12 experimental rats of a Wistar line: 4 -intact, 4 -with an induced malignant 101.8-glioma model and 4 -with an induced malignant C6-glioma model. In the intact rats, the cortex and the white matter were studied, in the rats with tumors -the central part of the tumor on the cortical surface, first in vivo and then ex vivo. Quantitative data evaluation of the CP OCT images involved calculation of attenuation coefficients for each tissue type.Results. A comparative qualitative image analysis of normal brain tissues and gliomas showed that the CP OCT images obtained ex vivo have the intensity and the attenuation rate (in both the initial and orthogonal polarizations) greater than those obtained in vivo. Quantitative analysis of the CP OCT images revealed significant statistical differences (p<0.02) between the attenuation coefficients from both tumors and the white matter in vivo (5. A comparison of the attenuation coefficients between the cortex and the white matter of the normal brain, as well as the white matter in the normal and malignant tissues, showed significant statistical differences both in vivo and ex vivo.Conclusion. The results of a qualitative comparative analysis of optical properties of normal and tumorous brain tissues using CP OCT allow us to conclude that the images obtained ex vivo show a full qualitative similarity with the structures observed with the intravital CP OCT study. Quantitative evaluation of CP OCT signals demonstrated a significant difference in the attenuation coefficient (p<0.005) between tumorous tissue, on the one hand, and normal white matter, on the other, both ex vivo and in vivo. However, when optical coefficients of tissues are evaluated in vivo, it is necessary to introduce adjustments based on the known differences between ex vivo and in vivo attenuation coefficients.

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“…These kinds of tumor can be characterized by aggressive infiltrative growth into the surrounding brain tissues and thereby the absence of clear boundaries between the cancer and non-cancer tissues, which makes it difficult to distinguish them during surgery in order to minimize the required extent of tumor resection. The introduction of intraoperative fluorescence diagnostics into clinical practice allows a significant enhancement of the ability to identify any remaining tumor, thereby increasing the survival rate [5][6][7][8][9]. Also, clinical testing of fluorescence techniques [10][11][12] has demonstrated the limitations of using only white light microscopy for achieving total tumor resection, and the requirement for using additional technologies for detecting the "cancer/non-cancer" dividing line.…”

Section: Introductionmentioning

confidence: 99%

Method for stereotactic biopsy guidance based on analysis of OCT images in two polarization channels

Moiseev¹,

Kiseleva²,

Yashin³

et al. 2020

Preprint

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The study aimed to create a machine learning method for differentiating diagnostically valued tumorous tissue from diagnostically “non-valued” non-tumorous tissues in the human brain, using cross-polarization optical coherence tomography (CP OCT) in order to provide guidance for stereotactic biopsies. A method of feature extraction from OCT data in two orthogonal polarization channels has been proposed and a classification algorithm for the resulting feature vectors has been created. If used for stereotactic biopsy guidance, the proposed approach could decrease the number of excised diagnostically non-valued samples and minimize the invasiveness of the procedure and the risk of excessive bleeding.

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Clinical guidelines for the use of intraoperative fluorescence diagnosis in brain tumor surgery

Cited by 19 publications

References 69 publications

Intraoperative Fluorescence Imaging for Personalized Brain Tumor Resection: Current State and Future Directions

Intraoperative Fluorescence Imaging for Personalized Brain Tumor Resection: Current State and Future Directions

Cross-Polarization Optical Coherence Tomography in Comparative in vivo and ex vivo Studies of the Optical Properties of Normal and Tumorous Brain Tissues

Method for stereotactic biopsy guidance based on analysis of OCT images in two polarization channels

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