Diagnostic Potential of Autofluorescence for an Assisted Intraoperative Delineation of Glioblastoma Resection Margins¶

Abstract

The intrinsic autofluorescence properties of biological tissues can be affected by the occurrence of histological and biochemical alterations induced by pathological processes. In this study the potential of autofluorescence to distinguish tumor from normal tissues was investigated with the view of a real-time diagnostic application in neurosurgery to delineate glioblastoma resection margins. The autofluorescence properties of nonneoplastic and neoplastic tissues were analyzed on tissue sections and homogenates by means of a microspectrofluorometer, and directly on patients affected by glioblastoma multiforme, during surgery, with a fiber-optic probe. Scanmicrospectrofluorometric analysis on tissue sections evidenced a reduction of emission intensity and a broadening of the main emission band, along with a redshift of the peak position, from peritumoral nonneoplastic to neoplastic tissues. Differences in both spectral shape and signal amplitude were found in patients when the glioblastoma lesion autofluorescence was compared with those of cortex and white matter taken as healthy tissues. Both biochemical composition and histological organization contribute to modify the autofluorescence emission of neoplastic, with respect to nonneoplastic, brain tissues. The differences found in the in vivo analysis confirm the prospects for improving the efficacy of tumor resection margin delineation in neurosurgery.

Compact point-detection fluorescence spectroscopy system for quantifying intrinsic fluorescence redox ratio in brain cancer diagnostics

“…However, because only one excitation wavelength (337 nm) was used to excite NADH fluorescence, there was no derivation of redox ratios attempted. Croce et al 7 investigated the autofluorescence properties of nonneoplastic and neoplastic brain tissues in tissue sections and homogenates by use of a microspectrofluorometer, and directly on patients affected by glioblastoma multiforme during surgery with a fiber-optic probe. They used a ratio of fluorescence intensities at 520 and 470 nm for an excitation wavelength of 405 nm to characterize the change in the spectral shape with neoplastic growth.…”

Review of the potential of optical technologies for cancer diagnosis in neurosurgery: a step toward intraoperative neurophotonics

“…Lin et al reported a discrimination algorithm based on the ratio of the fluorescence emission and reflectance intensity at 625 nm. 58 Croce et al 63 reported more comprehensive ex vivo (N ¼ 20) and in vivo (N ¼ 12) spectrofluorometric analysis of brain tissue. They reported a fluorescence intensity decrease and a broadening of the fluorescence emission band along with a redshift of the peak position in tumor compared to normal tissue, although some variability among the patients was observed.…”

The role of optical spectroscopy in epilepsy surgery in children

“…Several research groups have demonstrated the feasibility of using intrinsic fluorescence and optical characteristics to differentiate brain tumors from normal brain tissue in vivo over the past decade. 1,5,10,[21][22][23][24]47,51 In a recent clinical trial, the Vanderbilt group demonstrated high sensitivity with a combined optical spectroscopic method to detect the infiltrating brain tumor margins. 47 The feasibility of using intraoperative optical spectroscopy to detect and demarcate epileptic lesions has been investigated on only very few occasions.…”