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Published on: September 19, 2014
Preliminary Report: Rapid Intraoperative Detection of Residual Glioma Cell in Resection Cavity Walls Using a Compact
Jiro Akimoto1,2, Shinjiro Fukami2, Megumi Ichikawa2
1Department of Neurosurgery, Kohsei Chuo General Hospital, Tokyo 153-0062, Japan.
Objective:
The surgical eradication of malignant glioma cells is theoretically impossible. Therefore, reducing the number of remaining tumor cells around the brain-tumor interface (BTI) is crucial for achieving satisfactory clinical results. The usefulness of fluorescence-guided resection for the treatment of malignant glioma was recently reported, but the detection of infiltrating tumor cells in the BTI using a surgical microscope is not realistic. Therefore, we have developed an intraoperative rapid fluorescence cytology system, and exploratorily evaluated its clinical feasibility for the management of malignant glioma.
Materials And Methods:
A total of 25 selected patients with malignant glioma (newly diagnosed: 17; recurrent: 8) underwent surgical resection under photodiagnosis using photosensitizer Talaporfin sodium and a semiconductor laser. Intraoperatively, a crush smear preparation was made from a tiny amount of tumor tissue, and the fluorescence emitted upon 620/660 nm excitation was evaluated rapidly using a compact fluorescence microscope in the operating theater.
Results:
Fluorescence intensities of tumor tissues measured using a surgical microscope correlated with the tumor cell densities of tissues evaluated by measuring the red fluorescence emitted from the cytoplasm of tumor cells using a fluorescence microscope. A "weak fluorescence" indicated a reduction in the tumor cell density, whereas "no fluorescence" did not indicate the complete eradication of the tumor cells, but indicated that few tumor cells were emitting fluorescence.
Conclusion:
The rapid intraoperative detection of fluorescence from glioma cells using a compact fluorescence microscope was probably useful to evaluate the presence of tumor cells in the resection cavity walls, and could provide surgical implications for the more complete resection of malignant gliomas.
Insights
This study introduces a rapid intraoperative fluorescence cytology system to detect malignant glioma cells at the brain-tumor interface. The system helps surgeons assess residual tumor cells, improving the completeness of glioma resection.
Area of Science:
- Neurosurgery
- Oncology
- Medical Imaging
Background:
- Complete surgical eradication of malignant glioma is challenging due to infiltrating tumor cells.
- Current methods struggle to detect these cells at the brain-tumor interface (BTI).
- Fluorescence-guided surgery shows promise but requires improved intraoperative detection.
Purpose of the Study:
- To develop and evaluate the clinical feasibility of an intraoperative rapid fluorescence cytology system.
- To assess the system's utility in managing malignant glioma.
- To aid in the more complete resection of gliomas by detecting residual tumor cells.
Main Methods:
- Developed an intraoperative rapid fluorescence cytology system.
- Utilized Talaporfin sodium photosensitizer and a semiconductor laser for photodiagnosis.
- Analyzed crush smear preparations from tumor tissue using a compact fluorescence microscope.
Main Results:
- Fluorescence intensity correlated with tumor cell density in glioma tissues.
- "Weak fluorescence" indicated reduced tumor cell density.
- "No fluorescence" suggested few residual tumor cells, not complete eradication.
Conclusions:
- Rapid intraoperative fluorescence detection aids in evaluating glioma cell presence in resection cavity walls.
- The system offers surgical implications for achieving more complete malignant glioma resection.
- This technology could enhance surgical outcomes for glioma patients.
