Diagnostic accuracy of a confocal laser endomicroscope for in vivo differentiation between normal and tumor tissue during fluorescein-guided glioma resection: Laboratory investigation.

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Diagnostic accuracy of a confocal laser endomicroscope for in vivo differentiation between normal and tumor tissue during fluorescein-guided glioma resection: Laboratory investigation.

World Neurosurg. 2018 Apr 16;:

Authors: Belykh E, Miller EJ, Patel AA, Yazdanabadi MI, Martirosyan NL, Yağmurlu K, Bozkurt B, Byvaltsev VA, Eschbacher JM, Nakaji P, Preul MC

Abstract
OBJECTIVE: Glioma resection with fluorescein sodium (FNa) guidance has a potential drawback of nonspecific leakage of FNa from non-tumor areas with a compromised blood-brain barrier. We investigated the diagnostic accuracy of in vivo confocal laser endomicroscopy (CLE) after FNa administration to differentiate normal brain, injured normal brain, and tumor brain tissue in an animal glioma model.
METHODS: GL261-Luc2 gliomas in C57BL/6 mice were used as a brain tumor model. CLE images of normal, injured normal, and tumor brain tissues were collected after intravenous FNa administration. Correlative hematoxylin-and-eosin-stained sections were taken at the same sites. A set of 40 CLE images was given to 1 neuropathologist and 3 neurosurgeons to assess diagnostic accuracy and rate image quality (1-10 scale). Additionally, we developed a deep convolution neural network (DCNN) model for automatic image classification.
RESULTS: The mean observer accuracy for correct diagnosis of glioma compared to either injured or uninjured brain using CLE images was 85%, and the DCNN model accuracy was 80%. For differentiation of tumor from non-tumor tissue, the experts' mean accuracy, specificity, and sensitivity were 90%, 86%, and 96%, respectively, with high interobserver agreement overall (Cohen's kappa=0.74). The percentage of correctly identified images was significantly higher for images with a quality rating >5 (104/116, 90%) than for images with a quality rating ≤5 (32/44, 73%) (p=0.007).
CONCLUSIONS: With sufficient FNa present in tissues, CLE was an effective tool for intraoperative differentiation among normal, injured normal, and tumor brain tissue. Clinical studies are warranted to confirm these findings.

PMID: 29673821 [PubMed - as supplied by publisher]

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