Accuracy of Probe-Based Confocal Laser Endomicroscopy (pCLE) Miami Criteria at Identifying Low-Grade Dysplasia in Patients Undergoing Endoscopic Surveillance of Barrettʼs Esophagus

Abstract INTRODUCTION Low-grade gliomas (LGG) are the most common intra-axial brain tumors. Intraoperatively it's not possible to distinguish optically between the tumor and the normal tissue. Furthermore, it can not be detected with fluorescent agents like 5-aminolevulinacid (5-ALA). Those reasons often lead to inaccurate resection of the tumor. Confocal laser endomicroscopy (CLE) is a cellular imaging modality used for optical biopsies. The aim of this study was to use intraoperative CLE to differentiate tumor from normal tissue and to define borders during resection of LGG on a cellular level. METHODS We investigated the use of intraoperative CLE on 6 patients with LGG. We used a confocal system that is able to detect fluorescence on the infrared spectrum and we applied indocyanine green as a detecting fluorescent agent. We analyzed the accuracy of the intraoperative cellular CLE optical biopsies in comparison with the hematoxylin and eosin stains of the biopsies taken from the tumor and normal tissue borders area. RESULTS With CLE we were able intraoperatively to diagnose the tumor entity, normal brain structures, and vascularization modalities and to control the resection zone on a cellular level. Furthermore, CLE pictures showed exactly the cellular borders between tumor and normal tissue. The correlation of the CLE pictures with the H&E staining was 100%. CONCLUSION CLE, on one hand, allows intraoperative detection and differentiation of single tumor cells, while, on the other hand, it allows defining borders between tumor and normal tissue on a cellular level, dramatically improving the accuracy of surgical resection of LGG. The application and implementation of CLE-assisted surgery increases not only the options for real-tumor identification but also the therapeutic options by extending the resection borders of LGG on a cellular level and, more importantly, by protecting the functionality of normal tissue on the adjacent areas of the human brain.

Download Full-text

Intraoperative Probe-Based Confocal Laser Endomicroscopy in Surgery and Stereotactic Biopsy of Low-Grade and High-Grade Gliomas

Neurosurgery ◽

10.1227/neu.0000000000001365 ◽

2016 ◽

Vol 79 (4) ◽

pp. 604-612 ◽

Cited By ~ 19

Author(s):

Vladislav Pavlov ◽

David Meyronet ◽

Vincent Meyer-Bisch ◽

Xavier Armoiry ◽

Brian Pikul ◽

...

Keyword(s):

Open Surgery ◽

Stereotactic Biopsy ◽

Aminolevulinic Acid ◽

Intraoperative Imaging ◽

Intraoperative Complications ◽

Tumor Resection ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Low Grade ◽

Histologic Diagnosis

Abstract BACKGROUND: The management of gliomas is based on precise histologic diagnosis. The tumor tissue can be obtained during open surgery or via stereotactic biopsy. Intraoperative tissue imaging could substantially improve biopsy precision and, ultimately, the extent of resection. OBJECTIVE: To show the feasibility of intraoperative in vivo probe-based confocal laser endomicroscopy (pCLE) in surgery and biopsy of gliomas. METHODS: In our prospective observational study, 9 adult patients were enrolled between September 2014 and January 2015. Two contrast agents were used: 5-aminolevulinic acid (3 cases) or intravenous fluorescein (6 cases). Intraoperative imaging was performed with the Cellvizio system (Mauna Kea Technologies, Paris). A 0.85-mm probe was used for stereotactic procedures, with the biopsy needle modified to have a distal opening. During open brain surgery, a 2.36-mm probe was used. Each series corresponds to a separate histologic fragment. RESULTS: The diagnoses of the lesions were glioblastoma (4 cases), low-grade glioma (2), grade III oligoastrocytoma (2), and lymphoma (1). Autofluorescence of neurons in cortex was observed. Cellvizio images enabled differentiation of healthy “normal” tissue from pathological tissue in open surgery and stereotactic biopsy using fluorescein. 5-Aminolevulinic acid confocal patterns were difficult to establish. No intraoperative complications related to pCLE or to use of either contrast agent were observed. CONCLUSION: We report the initial feasibility and safety of intraoperative pCLE during primary brain tumor resection and stereotactic biopsy procedures. Pending further investigation, pCLE of brain tissue could be utilized for intraoperative surgical guidance, improvement in brain biopsy yield, and optimization of glioma resection via analysis of tumor margins.

Download Full-text