Toward intraoperative tissue classification: exploiting signal feedback from an ultrasonic aspirator for brain tissue differentiation

Abstract

Purpose During brain tumor surgery, care must be taken to accurately differentiate between tumorous and healthy tissue, as inadvertent resection of functional brain areas can cause severe consequences. Since visual assessment can be difficult during tissue resection, neurosurgeons have to rely on the mechanical perception of tissue, which in itself is inherently challenging. A commonly used instrument for tumor resection is the ultrasonic aspirator, whose system behavior is already dependent on tissue properties. Using data recorded during tissue fragmentation, machine learning-based tissue differentiation is investigated for the first time utilizing ultrasonic aspirators. Methods Artificial tissue model with two different mechanical properties is synthesized to represent healthy and tumorous tissue. 40,000 temporal measurement points of electrical data are recorded in a laboratory environment using a CNC machine. Three different machine learning approaches are applied: a random forest (RF), a fully connected neural network (NN) and a 1D convolutional neural network (CNN). Additionally, different preprocessing steps are investigated. Results Fivefold cross-validation is conducted over the data and evaluated with the metrics F1, accuracy, positive predictive value, true positive rate and area under the receiver operating characteristic. Results show a generally good performance with a mean F1 of up to 0.900 ± 0.096 using a NN approach. Temporal information indicates low impact on classification performance, while a low-pass filter preprocessing step leads to superior results. Conclusion This work demonstrates the first steps to successfully differentiate healthy brain and tumor tissue using an ultrasonic aspirator during tissue fragmentation. Evaluation shows that both neural network-based classifiers outperform the RF. In addition, the effects of temporal dependencies are found to be reduced when adequate data preprocessing is performed. To ensure subsequent implementation in the clinic, handheld ultrasonic aspirator use needs to be investigated in the future as well as the addition of data to reflect tissue diversity during neurosurgical operations.

Clinical applications of artificial intelligence in robotic surgery

“…Models were able to distinguish signal differences between native tissue and brain tumor, achieving a mean F1 of 0.900 using a neural network approach. Intraoperative deployment of these tissue models can help surgeons to resect malignancies while preserving as much healthy neural tissue as possible [ 9 ]. A final example of surgical margin management was presented by Bianchi et al in which they used preoperative multiparametric magnetic resonance imaging (mpMRI) to guide intraoperative frozen tissue sampling for margin detection during robot-assisted radical prostatectomy.…”