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

Abstract

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.

Sonobiopsy for minimally invasive, spatiotemporally-controlled, and sensitive detection of glioblastoma-derived circulating tumor DNA

“…QuPath v0.2.0 110 was used to detect areas of microhemorrhage and TUNEL expression. The imaged slice for mouse histological analysis was segmented into the tumor region of interest (ROI) that includes the tumor mass and extends 0.5 mm into its periphery, which is consistent with the safety objectives from previous studies 111 and the potential damage caused by the external and lumen diameters of a biopsy needle 112 , 113 . The parenchyma ROI was defined as the whole imaged slice without the tumor ROI.…”

Efficacy of a Second Brain Biopsy for Intracranial Lesions after Initial Negativity

“…Preoperative 5-ALA administration and the intraoperative assessment of fluorescence could improve the diagnostic yield of needle biopsies, especially for glioma and lymphoma patients. 29,30 Akshulakov et al 31 reported innovative intraoperative techniques for identifying viable pathological tissue, which included optical and molecular detection methods.…”

Fluorescence-Guided Surgery: A Review on Timing and Use in Brain Tumor Surgery

“…Fluorescein has been shown to be effective in predicting tumor pathology, especially in contrast-enhancing lesions ( 122 ), and in a proof-of-concept study, Lynagh et al found that in vivo fluorescein signal was strongly predictive of tumor tissue, and could be used to identify tumor prior to biopsy ( 123 ). Additionally, 5-ALA and ICG have been shown to be effective in identifying tumoral vessels, and 5-ALA, ICG and fluorescein can accurately detect tumor tissue prior to biopsy ( 124 ). By coupling fluorescence with confocal microscopy, identifying tumor tissue may now be feasible in real time without a frozen section ( 124 ), and may even increase the diagnostic yield, with Malinova et al finding that 5-ALA fluorescence had a higher sensitivity and negative predictive value for unclear cerebral pathologies compared to frozen section ( 125 ).…”

“…Additionally, 5-ALA and ICG have been shown to be effective in identifying tumoral vessels, and 5-ALA, ICG and fluorescein can accurately detect tumor tissue prior to biopsy ( 124 ). By coupling fluorescence with confocal microscopy, identifying tumor tissue may now be feasible in real time without a frozen section ( 124 ), and may even increase the diagnostic yield, with Malinova et al finding that 5-ALA fluorescence had a higher sensitivity and negative predictive value for unclear cerebral pathologies compared to frozen section ( 125 ). Second Window ICG has also been successfully used in stereotactic biopsy procedures, to assure the surgeon that the contrast-enhancing portion of the tumor has been biopsied ( 126 ).…”