The diagnostic accuracy of intraoperative differentiation and delineation techniques in brain tumours

Abstract

Brain tumour identification and delineation in a timeframe of seconds would significantly guide and support surgical decisions. Here, treatment is often complicated by the infiltration of gliomas in the surrounding brain parenchyma. Accurate delineation of the invasive margins is essential to increase the extent of resection and to avoid postoperative neurological deficits. Currently, histopathological annotation of brain biopsies and genetic phenotyping still define the first line treatment, where results become only available after surgery. Furthermore, adjuvant techniques to improve intraoperative visualisation of the tumour tissue have been developed and validated. In this review, we focused on the sensitivity and specificity of conventional techniques to characterise the tumour type and margin, specifically fluorescent-guided surgery, neuronavigation and intraoperative imaging as well as on more experimental techniques such as mass spectrometry-based diagnostics, Raman spectrometry and hyperspectral imaging. Based on our findings, all investigated methods had their advantages and limitations, guiding researchers towards the combined use of intraoperative imaging techniques. This can lead to an improved outcome in terms of extent of tumour resection and progression free survival while preserving neurological outcome of the patients.

Attention based multi-instance learning for improved glioblastoma detection using mass spectrometry

“…Currently, intraoperative MRI and 5-ALA fluorescence are the only available tools that can detect residual tumor. 5-ALA's ability to label tumor tissue at the margin of high-grade gliomas has been shown to have a sensitivity of 91% and specificity of 80%, while intraoperative MRI has a sensitivity of 66% and specificity of 60% [8]. However, the accuracy of these techniques relies on the interpretation of histological results and is largely dependent on the expertise and experience of the pathologist.…”

“…Precise correlation between preoperative imaging data and patient's brain anatomy is crucial for accurate tumor localization during surgery, but brain shift, and tissue deformation can disrupt this correlation. Conventional medical imaging improves the chance of successful treatment, but up to 65-80% of glioma surgeries still leave residual tumor tissue [8]. Moreover, surgeons lack intraoperative feedback to determine complete tumor removal.…”

Application of a Novel Miniaturized Histopathologic Microscope for Ex Vivo Identifying Cerebral Glioma Margins Rapidly During Surgery: A Parallel Control Study

“…To date, there are several kinds of intraoperative marginal exploration have been reported. These techniques are mainly divided into radiography technique, fluorescein-guided surgical technique, and optical technique 9 . The radiography technique only offers macroscopic visibility which is not suitable for principle of maximal resection 11 .…”

“…Hence, it is vital to precisely and swiftly define the boundaries of the glioma during surgery. This is necessary to minimize the amount of remaining tumor tissue and prevent over excision, which can lead to neurological deficits 9 …”

“…Because this procedure requires substantial time and exertion, rapid identification is unattainable, particularly in cases where there is a sizable residual cavity and multiple sites must be sampled 11 . Over recent decades, surgical techniques for delineating brain lesions have evolved greatly 9 . Microendoscope systems similar to Divescope such as Endoscopic Raman spectroscopy, 12 Multiphoton endomicroscopy, 13 and Confocal endomicroscopy 14 .…”