The Fluoropen: a simple low-cost device to detect intraoperative fluorescein fluorescence in stereotactic needle biopsy of brain tumors

Thien, Ady; Rao, Jai Prashanth; Ng, Wai Hoe; King, Nicolas Kon Kam

doi:10.1007/s00701-016-3041-8

Cited by 23 publications

(10 citation statements)

References 14 publications

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“…Even in non-contrast-enhancing lesions, fluorescein harbors a specificity of 72%. Hence, our data correspond with previous studies that have also reported on usefulness of fluorescein in stereotactic biopsies by increasing the diagnostic yield and shortening operative time, although they mainly focused on contrast-enhancing lesions [ 11 , 14 , 19 ].…”

Section: Discussionsupporting

confidence: 91%

Correlation of Tumor Pathology with Fluorescein Uptake and MRI Contrast-Enhancement in Stereotactic Biopsies

Rösler

Teich

et al. 2022

JCM

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The utilization of fluorescein-guided biopsies has recently been discussed to improve and expedite operative techniques in the detection of tumor-positive tissue, as well as to avoid making sampling errors. In this study, we aimed to report our experience with fluorescein-guided biopsies and elucidate distribution patterns in different histopathological diagnoses in order to develop strategies to increase the efficiency and accuracy of this technique. We report on 45 fluorescence-guided stereotactic biopsies in 44 patients (15 female, 29 male) at our institution from March 2016 to March 2021, including 25 frame-based stereotactic biopsies and 20 frameless image-guided biopsies using VarioGuide®. A total number of 347 biopsy samples with a median of 8 samples (range: 4–18) per patient were evaluated for intraoperative fluorescein uptake and correlated to definitive histopathology. The median age at surgery was 63 years (range: 18–87). Of the acquired specimens, 63% were fluorescein positive. Final histopathology included glioblastoma (n = 16), B-cell non-Hodgkin lymphoma (n = 10), astrocytoma, IDH-mutant WHO grade III (n = 6), astrocytoma, IDH-mutant WHO grade II (n = 1), oligodendroglioma, IDH-mutant and 1p/19q-codeleted WHO grade II (n = 2), reactive CNS tissue/inflammation (n = 4), post-transplantation lymphoproliferative disorder (PTLD; n = 2), ependymoma (n = 1), infection (toxoplasmosis; n = 1), multiple sclerosis (n = 1), and metastasis (n = 1). The sensitivity for high-grade gliomas was 85%, and the specificity was 70%. For contrast-enhancing lesions, the specificity of fluorescein was 84%. The number needed to sample for contrast-enhancing lesions was three, and the overall number needed to sample for final histopathological diagnosis was five. Interestingly, in the astrocytoma, IDH-mutant WHO grade III group, 22/46 (48%) demonstrated fluorescein uptake despite no evidence for gadolinium uptake, and 73% of these were tumor-positive. In our patient series, fluorescein-guided stereotactic biopsy increases the likelihood of definitive neuropathological diagnosis, and the number needed to sample can be reduced by 50% in contrast-enhancing lesions.

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Section: Discussionsupporting

confidence: 91%

Correlation of Tumor Pathology with Fluorescein Uptake and MRI Contrast-Enhancement in Stereotactic Biopsies

Rösler

Teich

et al. 2022

JCM

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“…[ 22 , 34 , 37 , 51 , 52 ] However, as aforementioned, its use has been reported only in 13 out of 57 studies on stereotactic biopsy in humans. [ 2 , 6 , 12 , 28 , 32 , 34 - 36 , 51 , 52 , 54 , 55 , 57 ] Furthermore, it increases the operative time and, consequently, the risk of complications. [ 35 ] Maybe even more importantly, the accuracy rate of this technique in the central nervous system lesions is only 77.9%, when compared to permanent section.…”

Section: Discussionmentioning

confidence: 99%

“…[ 52 ] However, on reviewing the literature over a period of 5 years (pubmed.com: June 2015/June 2020), only 13 out of the 59 original publications on stereotactic biopsy in humans[ 1 - 59 ] reported the use of frozen section. [ 2 , 6 , 12 , 28 , 32 , 34 - 36 , 51 , 52 , 54 , 55 , 57 ] In cases of cystic lesions, such as brain abscesses, the mere aspiration of pus is enough to confirm appropriate targeting, making pathology consultation unnecessary.…”

Section: Introductionmentioning

confidence: 99%

Indicators of correct targeting in stereotactic biopsy of intracranial lesions

Vilela‐Filho¹,

Porfírio²,

Goulart³

2022

Surgical Neurology International

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Background: Confirmation of whether a stereotactic biopsy was performed in the correct site is usually dependent on the frozen section or on novel tumor-specific markers that are not widely available. Immediate postoperative computed tomography (CT) or magnetic resonance (MR) is routinely performed in our service after biopsy. In this retrospective study, we have carefully analyzed these images in an attempt to determine the presence of markers that indicate appropriate targeting. Methods: Medical records and neuroimages of patients who underwent stereotactic biopsy of intracranial lesions were reviewed. The following variables were assessed: age, sex, anatomopathology, lesion site, complications, diagnostic accuracy, and the presence of image markers. Results: Twenty-nine patients were included in this case series. About 96.6% of the biopsies were accurate according to the permanent section. Of the 86.2% of patients with intralesional pneumocephalus on the postoperative images, 51.7% additionally presented petechial hemorrhage. In 13.8% of the cases, no image markers were identified. Conclusion: This is the first report of intralesional pneumocephalus and petechial hemorrhage as indicators of appropriate targeting in stereotactic biopsy. In the majority of the cases, an immediate postoperative head CT, which is widely available, can estimate how adequate the targeting is. To use intralesional pneumocephalus/ petechial hemorrhages as not only postoperative but also as intraoperative markers of appropriate targeting, it is advised that the surgical wound should be temporarily closed and dressed after the biopsy so that the patient can undergo a CT/MR scan and be checked for the presence of theses markers before removing the stereotactic frame.

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“…High-grade glioma tissue shows strong yellow fluorescence when excited at about 488 nm (47). Being a relatively inexpensive drug, fluorescein sodium could also be visualized using a low-cost miniature device, Fluoropen, which is essentially a LED torch with a blue filter mounted at the light source for excitation and a yellow filter attached around the torch as a cone collar (48). The device is positioned close to the specimen and yellow fluorescence is observed through the yellow filter (48).…”

Section: Methods For Biopsy Acquisition Guidance and For Rapid Intraomentioning

confidence: 99%

“…Being a relatively inexpensive drug, fluorescein sodium could also be visualized using a low-cost miniature device, Fluoropen, which is essentially a LED torch with a blue filter mounted at the light source for excitation and a yellow filter attached around the torch as a cone collar (48). The device is positioned close to the specimen and yellow fluorescence is observed through the yellow filter (48). Observation of fluorescein fluorescence from the specimens had a 100% positive predictive value and a 25% negative predictive value of a lesional tissue (49).…”

Section: Methods For Biopsy Acquisition Guidance and For Rapid Intraomentioning

confidence: 99%

Current Trends for Improving Safety of Stereotactic Brain Biopsies: Advanced Optical Methods for Vessel Avoidance and Tumor Detection

Akshulakov¹,

Kerimbayev²,

Biryuchkov

et al. 2019

Front. Oncol.

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Stereotactic brain needle biopsies are indicated for deep-seated or multiple brain lesions and for patients with poor prognosis in whom the risks of resection outweigh the potential outcome benefits. The main goal of such procedures is not to improve the resection extent but to safely acquire viable tissue representative of the lesion for further comprehensive histological, immunohistochemical, and molecular analyses. Herein, we review advanced optical techniques for improvement of safety and efficacy of stereotactic needle biopsy procedures. These technologies are aimed at three main areas of improvement: (1) avoidance of vessel injury, (2) guidance for biopsy acquisition of the viable diagnostic tissue, and (3) methods for rapid intraoperative assessment of stereotactic biopsy specimens. The recent technological developments in stereotactic biopsy probe design include the incorporation of fluorescence imaging, spectroscopy, and label-free imaging techniques. The future advancements of stereotactic biopsy procedures in neuro-oncology include the incorporation of optical probes for real-time vessel detection along and around the biopsy needle trajectory and in vivo confirmation of the diagnostic tumor tissue prior to sample acquisition.

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The Fluoropen: a simple low-cost device to detect intraoperative fluorescein fluorescence in stereotactic needle biopsy of brain tumors

Cited by 23 publications

References 14 publications

Correlation of Tumor Pathology with Fluorescein Uptake and MRI Contrast-Enhancement in Stereotactic Biopsies

Correlation of Tumor Pathology with Fluorescein Uptake and MRI Contrast-Enhancement in Stereotactic Biopsies

Indicators of correct targeting in stereotactic biopsy of intracranial lesions

Current Trends for Improving Safety of Stereotactic Brain Biopsies: Advanced Optical Methods for Vessel Avoidance and Tumor Detection

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