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Fluorescence Spectroscopy Measurements in Ultrasonic Navigated Resection of Malignant Brain Tumors

Richter, Johan C. O. ; Haj-Hosseini, Neda ; Andersson-Engels, Stefan LU and Wardell, Karin (2011) In Lasers in Surgery and Medicine 43(1). p.8-14
Abstract
Background and Objective: Glioblastoma multiforme is a highly malignant primary brain tumor. It has no border but at best a marginal zone, however, invisible to the surgeon. An optical touch pointer (OTP) enabling differentiation of healthy and tumor tissue by means of fiber-optic fluorescence spectroscopy has been developed. In combination with an ultrasonic navigation system, the OTP may be used for demarcation of resectable tumor tissue. The aim of the study was to evaluate the clinical performance of OTP during surgery of malignant brain tumors. Study Design/Materials and Methods: Nine patients were operated on with the standard surgical procedure, including white light microscopy and navigation. A total of 5 mg/kg bodyweight of... (More)
Background and Objective: Glioblastoma multiforme is a highly malignant primary brain tumor. It has no border but at best a marginal zone, however, invisible to the surgeon. An optical touch pointer (OTP) enabling differentiation of healthy and tumor tissue by means of fiber-optic fluorescence spectroscopy has been developed. In combination with an ultrasonic navigation system, the OTP may be used for demarcation of resectable tumor tissue. The aim of the study was to evaluate the clinical performance of OTP during surgery of malignant brain tumors. Study Design/Materials and Methods: Nine patients were operated on with the standard surgical procedure, including white light microscopy and navigation. A total of 5 mg/kg bodyweight of 5-amino-levulin acid was orally administrated before surgery. The OTP was calibrated into the ultrasound-based navigation system and measurements were performed in tumor core and along the tumor border. The ratio between the protoporphyrin IX fluorescence at 635 nm and the autofluorescence was used for quantifications of data. Biopsies (n = 20), ultrasound images (n = 30), and visual inspection (n = 180) were compared to the fluorescence ratio. Results/Conclusion : Healthy and tumor tissue could be identified and differentiated with the OTP(P < 0.001). The fluorescence ratio in average was 0 outside the tumor and low in the gliotic edema zone around the tumor. It increased in the marginal zone and was highest in the solid tumor tissue. In the necrotic tissue, in the center of the tumor, the ratio in average was 0. The OTP can be used in combination with ultrasound-based navigation and may help to determine whether to resect otherwise not identifiable tissue. Lasers Surg. Med. 43:8-14, 2011. (C) 2011 Wiley-Liss, Inc. (Less)
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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
5-amino-levulin acid (5-ALA), fluorescence-guided resection (FGR), glioblastoma multiforme, optical touch pointer (OTP), protoporphyrin IX, (PpIX) fluorescence, ultrasound navigation
in
Lasers in Surgery and Medicine
volume
43
issue
1
pages
8 - 14
publisher
John Wiley & Sons Inc.
external identifiers
  • wos:000286440300002
  • scopus:79251503604
  • pmid:21254137
ISSN
0196-8092
DOI
10.1002/lsm.21022
language
English
LU publication?
yes
id
62b0c0f4-851f-4862-8870-4f188c45f5b3 (old id 1869105)
date added to LUP
2016-04-01 12:53:08
date last changed
2022-04-06 01:16:25
@article{62b0c0f4-851f-4862-8870-4f188c45f5b3,
  abstract     = {{Background and Objective: Glioblastoma multiforme is a highly malignant primary brain tumor. It has no border but at best a marginal zone, however, invisible to the surgeon. An optical touch pointer (OTP) enabling differentiation of healthy and tumor tissue by means of fiber-optic fluorescence spectroscopy has been developed. In combination with an ultrasonic navigation system, the OTP may be used for demarcation of resectable tumor tissue. The aim of the study was to evaluate the clinical performance of OTP during surgery of malignant brain tumors. Study Design/Materials and Methods: Nine patients were operated on with the standard surgical procedure, including white light microscopy and navigation. A total of 5 mg/kg bodyweight of 5-amino-levulin acid was orally administrated before surgery. The OTP was calibrated into the ultrasound-based navigation system and measurements were performed in tumor core and along the tumor border. The ratio between the protoporphyrin IX fluorescence at 635 nm and the autofluorescence was used for quantifications of data. Biopsies (n = 20), ultrasound images (n = 30), and visual inspection (n = 180) were compared to the fluorescence ratio. Results/Conclusion : Healthy and tumor tissue could be identified and differentiated with the OTP(P &lt; 0.001). The fluorescence ratio in average was 0 outside the tumor and low in the gliotic edema zone around the tumor. It increased in the marginal zone and was highest in the solid tumor tissue. In the necrotic tissue, in the center of the tumor, the ratio in average was 0. The OTP can be used in combination with ultrasound-based navigation and may help to determine whether to resect otherwise not identifiable tissue. Lasers Surg. Med. 43:8-14, 2011. (C) 2011 Wiley-Liss, Inc.}},
  author       = {{Richter, Johan C. O. and Haj-Hosseini, Neda and Andersson-Engels, Stefan and Wardell, Karin}},
  issn         = {{0196-8092}},
  keywords     = {{5-amino-levulin acid (5-ALA); fluorescence-guided resection (FGR); glioblastoma multiforme; optical touch pointer (OTP); protoporphyrin IX; (PpIX) fluorescence; ultrasound navigation}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{8--14}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Lasers in Surgery and Medicine}},
  title        = {{Fluorescence Spectroscopy Measurements in Ultrasonic Navigated Resection of Malignant Brain Tumors}},
  url          = {{https://lup.lub.lu.se/search/files/3028816/2370759.pdf}},
  doi          = {{10.1002/lsm.21022}},
  volume       = {{43}},
  year         = {{2011}},
}