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Validating a new generation filter system for visualizing 5-ALA-induced PpIX fluorescence in malignant glioma surgery: a proof of principle study.
Acta Neurochirurgica ( IF 2.4 ) Pub Date : 2020-02-07 , DOI: 10.1007/s00701-020-04227-7
Eric Suero Molina 1 , Louise Stögbauer 1 , Astrid Jeibmann 2 , Nils Warneke 1 , Walter Stummer 1
Affiliation  

BACKGROUND The BLUE 400 filter system (Carl Zeiss Meditec, Oberkochen, Germany) has provided visualization of 5-ALA-induced fluorescence-guided surgery for more than 20 years. Nevertheless, constraints, e.g., limited background discrimination during hemostasis, obstruct fluency of surgery. A novel filter with improved background visualization was developed, requiring validation regarding fluorescence discrimination. The aim of this article is to determine diagnostic accuracy and perception of protoporphyrin IX (PpIX) discrimination of a novel filter system with higher background illumination (BLUE 400 AR) compared with the gold standard, BLUE 400. METHODS A surgical microscope equipped with both BLUE 400 and BLUE 400 AR was used. Comparisons were performed on a biological basis and on the visual perception of margins. High-resolution images were compared during and after surgery by senior neurosurgeons. In a predefined biopsy algorithm, four biopsies per patient at tumor margins of PpIX fluorescence and adjacent brain were acquired using BLUE 400 AR only from regions intended for resection and assessed for cell count and density. RESULTS Thirty-two patients with malignant gliomas were included in this study. BLUE 400 AR markedly enhanced the brightness of the surgical field, allowing superior discrimination of brain anatomy. A total of 128 biopsies from fluorescence margins were collected. Positive predictive value (PPV) was 98.44% (95% CI, 90.06-99.77%) for malignant glioma. Residual median cell density in non-fluorescent tissue was 13% (IQR 13 to 31). Perception of the location of fluorescent margins on HD images was equivalent for both filter combinations. CONCLUSIONS BLUE 400 AR demonstrated superior background compared with conventional BLUE 400 in malignant glioma surgery but comparable fluorescence margins and PPV. Therefore, BLUE 400 AR can be considered safe and effective in supporting malignant glioma surgery.

中文翻译:

验证用于在恶性胶质瘤手术中可视化 5-ALA 诱导的 PpIX 荧光的新一代过滤器系统:原理研究的证明。

背景 BLUE 400 过滤系统(Carl Zeiss Meditec,Oberkochen,Germany)提供 5-ALA 诱导的荧光引导手术的可视化已有 20 多年。然而,限制,例如,在止血期间有限的背景辨别,阻碍了手术的流畅性。开发了一种具有改进的背景可视化的新型过滤器,需要对荧光辨别进行验证。本文的目的是确定与金标准 BLUE 400 相比,具有更高背景照明 (BLUE 400 AR) 的新型过滤系统对原卟啉 IX (PpIX) 鉴别的诊断准确性和感知。使用了 400 和 BLUE 400 AR。比较是在生物学基础上和边缘的视觉感知上进行的。高级神经外科医生在手术期间和之后比较了高分辨率图像。在预定义的活检算法中,使用 BLUE 400 AR 仅从打算切除的区域获取每个患者在 PpIX 荧光和相邻大脑的肿瘤边缘处的四次活检,并评估细胞计数和密度。结果 本研究共纳入 32 名恶性胶质瘤患者。BLUE 400 AR 显着增强了手术视野的亮度,可以更好地识别脑解剖结构。共收集了 128 个来自荧光边缘的活组织检查。恶性胶质瘤的阳性预测值 (PPV) 为 98.44% (95% CI, 90.06-99.77%)。非荧光组织中残留的中值细胞密度为 13%(IQR 13 至 31)。两种滤光片组合对高清图像上荧光边缘位置的感知是等效的。结论 BLUE 400 AR 在恶性胶质瘤手术中表现出优于传统 BLUE 400 的背景,但荧光边缘和 PPV 相当。因此,BLUE 400 AR 在支持恶性胶质瘤手术方面可以被认为是安全有效的。
更新日期:2020-02-07
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