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Longitudinal Intravital Imaging of Brain Tumor Cell Behavior in Response to an Invasive Surgical Biopsy
Published on: May 3, 2019
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In situ optical feedback in brain tumor biopsy: A multiparametric analysis
Elisabeth Klint1, Johan Richter2,1, Peter Milos3,2
1Department of Biomedical Engineering, Linköping University, Linköping, Sweden.
Neuro-Oncology Advances
|December 17, 2024
Summary
Optical guidance during brain tumor biopsies improves diagnostic accuracy and reduces procedure time. Real-time feedback on protoporphyrin IX fluorescence and microcirculation enhances tissue selection, minimizing nondiagnostic samples and improving patient outcomes.
Area of Science:
- Neurosurgery
- Oncology
- Medical Imaging
Background:
- Brain tumor needle biopsies face challenges with nondiagnostic sampling (up to 25%) and hemorrhage (up to 60%).
- Intraoperative optical techniques are explored to identify diagnostic tissue and areas of increased microcirculation.
- This study investigates the clinical utility of in situ optical guidance in frameless navigated tumor biopsies.
Purpose of the Study:
- To evaluate the clinical implications of real-time optical guidance during frameless navigated brain tumor biopsies.
- To assess the correlation between optical feedback (protoporphyrin IX fluorescence, microcirculation) and neuropathological findings.
- To determine the impact of optical guidance on biopsy precision, hemorrhage incidence, and operation time.
Main Methods:
- Real-time feedback on protoporphyrin IX (PpIX) fluorescence, microcirculation, and tissue appearance was provided at 272 sampling positions across 21 trajectories in 20 patients.
- Key variables included PpIX fluorescence in relation to neuropathology and gadolinium enhancement, microcirculation in relation to bleeding, and operation time.
- Optical data was analyzed for its correlation with diagnostic yield and procedural efficiency.
Main Results:
- PpIX fluorescence was detected in high-grade tumors like Glioblastoma IDH-wildtype (n=12) and Primary diffuse large B-cell lymphoma (n=3).
- Increased microcirculation was observed in 34 sites along 9 trajectories, located in various brain regions.
- Postoperative bleeding (10 cases, 9 asymptomatic) was associated with surgical access rather than tissue sampling guided by optical feedback. Objective feedback led to fewer trajectories, suggesting reduced operation time.
Conclusions:
- Integrated optical guidance systems offer in situ, real-time feedback for frameless brain tumor biopsies.
- This technology enhances the certainty and precision of selecting diagnostic tissue prior to sampling.
- Optical guidance aids in identifying optimal biopsy sites, potentially improving diagnostic yield and procedural efficiency.
