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

机译:手持探头和显微镜的结合在脑肿瘤边缘区域进行荧光引导手术

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摘要

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.
机译:背景技术肿瘤的可视化对于在手术期间尤其是在肿瘤边缘区域中将恶性组织与健康的大脑区分开至关重要。这项研究的目的是结合荧光引导切除手术显微镜(FGR-显微镜),引入基于荧光光谱的手持式探针(HHF-probe)用于肿瘤鉴定,并对它们的诊断性能和实用性进行评估荧光检测方面。材料和方法对16例疑似高度神经胶质瘤的患者进行了18次手术。使用HHF探针和FGR显微镜检测由5-氨基乙酰丙酸(5-ALA)诱导的原卟啉(PpIX)荧光,并通过医生通过FGR显微镜对组织病理学分析和视觉分级进行评估。 PpIX荧光强度与自发荧光强度之比(荧光比)用于量化探针检测到的光谱。结果探针测得的荧光比中值(范围0 – 40)与FGR显微镜中的荧光强度有关,分为“无”(0.3,n,= 131),“弱”(1.6,n = 34)。 )和“强”(5.4,n = 28)。在FGR显微镜的131个“无”点中,有88个(67%)用HHF探针显示出荧光。对于肿瘤边缘区域,FGR显微镜的接收器操作员特征(ROC)曲线下的面积为0.49,HHF探针的接收器操作员特征(ROC)曲线下的面积为0.65。结论使用FGR显微镜将探针整合到既定的肿瘤切除常规中。 HHF探针的灵敏度优于FGR显微镜。它在FGR显微镜下消灭后检测到了肿瘤残留。 HHF探针和FGR显微镜的组合特别有益于肿瘤边缘区域。

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