scholarly journals Socio-Organizational Impact of Confocal Laser Endomicroscopy in Neurosurgery and Neuropathology: Results from a Process Analysis and Expert Survey

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2128
Author(s):  
Marina L. Fotteler ◽  
Friederike Liesche-Starnecker ◽  
Maria C. Brielmaier ◽  
Johannes Schobel ◽  
Jens Gempt ◽  
...  
Keyword(s):  
Tissue Sample ◽  
Process Analysis ◽  
Tumor Resection ◽  
Routine Care ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Organizational Impact ◽  
Expert Survey ◽  
Current Process ◽  
Use Of Resources

During brain tumor resection surgery, it is essential to determine the tumor borders as the extent of resection is important for post-operative patient survival. The current process of removing a tissue sample for frozen section analysis has several shortcomings that might be overcome by confocal laser endomicroscopy (CLE). CLE is a promising new technology enabling the digital in vivo visualization of tissue structures in near real-time. Research on the socio-organizational impact of introducing this new methodology to routine care in neurosurgery and neuropathology is scarce. We analyzed a potential clinical workflow employing CLE by comparing it to the current process. Additionally, a small expert survey was conducted to collect data on the opinion of clinical staff working with CLE. While CLE can contribute to a workload reduction for neuropathologists and enable a shorter process and a more efficient use of resources, the effort for neurosurgeons and surgery assistants might increase. Experts agree that CLE offers huge potential for better diagnosis and therapy but also see challenges, especially due to the current state of experimental use, including a risk for misinterpretations and the need for special training. Future studies will show whether CLE can become part of routine care.

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

Neurosurgery ◽  
2016 ◽  
Vol 79 (4) ◽  
pp. 604-612 ◽  
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.

scholarly journals Fluorescent Imaging and Multifusion Segmentation for Enhanced Visualization and Delineation of Glioblastomas Margins

Signals ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 304-335
Author(s):  
Aditi Deshpande ◽  
Thomas Cambria ◽  
Charles Barnes ◽  
Alexandros Kerwick ◽  
George Livanos ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Fluorescent Protein ◽  
Image Acquisition ◽  
Tumor Resection ◽  
Fluorescent Imaging ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Test Bed ◽  
Tumor Margins ◽  
Green Fluorescent

This study investigates the potential of fluorescence imaging in conjunction with an original, fused segmentation framework for enhanced detection and delineation of brain tumor margins. By means of a test bed optical microscopy system, autofluorescence is utilized to capture gray level images of brain tumor specimens through slices, obtained at various depths from the surface, each of 10 µm thickness. The samples used in this study originate from tumor cell lines characterized as Gli36ϑEGRF cells expressing a green fluorescent protein. An innovative three-step biomedical image analysis framework is presented aimed at enhancing the contrast and dissimilarity between the malignant and the remaining tissue regions to allow for enhanced visualization and accurate extraction of tumor boundaries. The fluorescence image acquisition system implemented with an appropriate unsupervised pipeline of image processing and fusion algorithms indicates clear differentiation of tumor margins and increased image contrast. Establishing protocols for the safe administration of fluorescent protein molecules, these would be introduced into glioma tissues or cells either at a pre-surgery stage or applied to the malignant tissue intraoperatively; typical applications encompass areas of fluorescence-guided surgery (FGS) and confocal laser endomicroscopy (CLE). As a result, this image acquisition scheme could significantly improve decision-making during brain tumor resection procedures and significantly facilitate brain surgery neuropathology during operation.

scholarly journals Intraoperative free margins assessment of oropharyngeal squamous cell carcinoma with confocal laser endomicroscopy: a pilot study

2021 ◽  
Author(s):  
Matti Sievert ◽  
Florian Stelzle ◽  
Marc Aubreville ◽  
Sarina K. Mueller ◽  
Markus Eckstein ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Pilot Study ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Tumor Resection ◽  
Oropharyngeal Squamous Cell Carcinoma ◽  
Optical Biopsy ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Uniform Size

Abstract Purpose This pilot study aimed to assess the feasibility of intraoperative assessment of safe margins with confocal laser endomicroscopy (CLE) during oropharyngeal squamous cell carcinoma (OPSCC) surgery. Methods We included five consecutive patients confirmed OPSCC and planned tumor resection in September and October 2020. Healthy appearing mucosa in the marginal zone, and the tumor margin, were examined with CLE and biopsy during tumor resection. A total of 12,809 CLE frames were correlated with the gold standard of hematoxylin and eosin staining. Three head and neck surgeons and one pathologist were asked to identify carcinoma in a sample of 169 representative images, blinded to the histological results. Results Healthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. CLE optical biopsy of OPSCC demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, PPV, and NPV of 86%, 90%, 79%, 88%, and 82%, respectively, with inter-rater reliability and κ-value of 0.60. Conclusion CLE can be easily integrated into the intraoperative setting, generate real-time, in-vivo microscopic images of the oropharynx for evaluation and demarcation of cancer. It can eventually contribute to a less radical approach by enabling a more precise evaluation of the cancer margin.

scholarly journals Fluorescein- and EGFR-Antibody Conjugated Silica Nanoparticles for Enhancement of Real-time Tumor Border Definition Using Confocal Laser Endomicroscopy in Squamous Cell Carcinoma of the Head and Neck

Nanomaterials ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. 1378 ◽  
Author(s):  
Anna Watermann ◽  
Rita Gieringer ◽  
Anna-Maria Bauer ◽  
Sven Kurch ◽  
Ralf Kiesslich ◽  
...  
Keyword(s):  
Head And Neck ◽  
Silica Nanoparticles ◽  
Laser Scanning ◽  
Ex Vivo ◽  
Tumor Resection ◽  
Laser Scanning Microscopy ◽  
Confocal Laser Endomicroscopy ◽  
Resection Margins ◽  
Confocal Laser ◽  
Definition Of

Intraoperative definition of tumor free resection margins in head and neck cancer is challenging. In the current proof-of-principle study we evaluated a novel silica nanoparticle-based agent for its potential use as contrast enhancer. We synthesized silica nanoparticles with an average size of 45 nm and modified these particles with the fluorescence stain fluorescein isocyanate (FITC) for particle detection and with epidermal growth factor receptor (EGFR)-targeting antibodies for enhanced tumor specificity. The nanoparticles exhibited good biocompatibility and could be detected in vitro and in vivo by confocal laser scanning microscopy. Additionally, we show in an ex vivo setting that these modified nanoparticles specifically bind to tumor samples and could be detected using a handheld confocal fluorescence endomicroscope. From a clinical point of view, we believe that this method could be used for tumor border contrast enhancement and for better intraoperative definition of R-0 tumor resection.

Sign in / Sign up

Export Citation Format

Share Document