P14.15.A INTRAOPERATIVE ASPIRATE TISSUE MONITORING DURING 5-ALA GUIDED HIGH-GRADE GLIOMA SURGERY

P14.15.A INTRAOPERATIVE ASPIRATE TISSUE MONITORING DURING 5-ALA GUIDED HIGH-GRADE GLIOMA SURGERY

Abstract BACKGROUND The first-line treatment for high-grade gliomas (HGG) is maximal safe resection, which is limited by diffuse tumor margins and nearby eloquent areas. Intraoperative detection of tumor cells is improved with fluorescence-guided surgery using 5-ALA, but its visual detection is limi...

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Veröffentlicht in:Neuro-oncology (Charlottesville, Va.) Va.), 2024-10, Vol.26 (Supplement_5), p.v80-v81
Hauptverfasser: Elomaa, A, Lehtonen, S, von und zu Fraunberg, M, Charbel, F, Luoma, J, Visuri, M, Haapala, I, Haapasalo, J, Vik-Mo, E, Puustinen, S
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container_issue Supplement_5
container_start_page v80
container_title Neuro-oncology (Charlottesville, Va.)
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creator Elomaa, A
Lehtonen, S
von und zu Fraunberg, M
Charbel, F
Luoma, J
Visuri, M
Haapala, I
Haapasalo, J
Vik-Mo, E
Puustinen, S
description Abstract BACKGROUND The first-line treatment for high-grade gliomas (HGG) is maximal safe resection, which is limited by diffuse tumor margins and nearby eloquent areas. Intraoperative detection of tumor cells is improved with fluorescence-guided surgery using 5-ALA, but its visual detection is limited by blood, obstacles and weakness of the fluorescence. Aspirate tissue monitoring (ATM) of fluorescence from surgical suction waste could improve surgical performance by providing objective feedback while maintaining a natural white light anatomical view. This observational study compared the visual detection of 5-ALA fluorescence to feedback from an ATM device. MATERIALS AND METHODS Twelve (n=12) patients’ suspected HGG resection with (n=9) and without (n=3) prescribed 5-ALA were recorded while a prototype ATM, was attached to the tube of an ultrasonic aspirator. Seven (7) neurosurgeons viewed the white and blue light operation videos with and without ATM feedback and responded to a questionnaire assessing the safety and benefit-risk ratio of ATM. According to the averaged experts’ analysis, the resected tissues were categorized to visually perceivable fluorescence (yes/no) and compared to the ATM signals. RESULTS In total 42 video sequences were analyzed. The sensitivity and specificity of ATM in comparison to visual analysis was 100% and 80%, respectively. The positive predictive value (PPV) of ATM was 92% and the negative predictive value (NPV) was 100%. The ATM detected fluorescence under white light in 11 of the resected areas, whereas experts in 0 areas (p
doi_str_mv 10.1093/neuonc/noae144.266
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Intraoperative detection of tumor cells is improved with fluorescence-guided surgery using 5-ALA, but its visual detection is limited by blood, obstacles and weakness of the fluorescence. Aspirate tissue monitoring (ATM) of fluorescence from surgical suction waste could improve surgical performance by providing objective feedback while maintaining a natural white light anatomical view. This observational study compared the visual detection of 5-ALA fluorescence to feedback from an ATM device. MATERIALS AND METHODS Twelve (n=12) patients’ suspected HGG resection with (n=9) and without (n=3) prescribed 5-ALA were recorded while a prototype ATM, was attached to the tube of an ultrasonic aspirator. Seven (7) neurosurgeons viewed the white and blue light operation videos with and without ATM feedback and responded to a questionnaire assessing the safety and benefit-risk ratio of ATM. According to the averaged experts’ analysis, the resected tissues were categorized to visually perceivable fluorescence (yes/no) and compared to the ATM signals. RESULTS In total 42 video sequences were analyzed. The sensitivity and specificity of ATM in comparison to visual analysis was 100% and 80%, respectively. The positive predictive value (PPV) of ATM was 92% and the negative predictive value (NPV) was 100%. The ATM detected fluorescence under white light in 11 of the resected areas, whereas experts in 0 areas (p&lt;0.001). 10/11 of these areas were verified to include strong visual fluorescence under blue light according to experts’ analysis. The neurosurgeons agreed that ATM appears safe and adds value to contemporary navigation techniques with good agreement (averaged overall agreement rate = 96,7%). CONCLUSIONS The ATM improved intraoperative detection of fluorescence compared to visual analysis. The safety and benefit-risk assessment depicts non-inferiority compared to visual analysis for detecting fluorescence during HGG surgery.</description><identifier>ISSN: 1522-8517</identifier><identifier>EISSN: 1523-5866</identifier><identifier>DOI: 10.1093/neuonc/noae144.266</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>Neuro-oncology (Charlottesville, Va.), 2024-10, Vol.26 (Supplement_5), p.v80-v81</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>Elomaa, A</creatorcontrib><creatorcontrib>Lehtonen, S</creatorcontrib><creatorcontrib>von und zu Fraunberg, M</creatorcontrib><creatorcontrib>Charbel, F</creatorcontrib><creatorcontrib>Luoma, J</creatorcontrib><creatorcontrib>Visuri, M</creatorcontrib><creatorcontrib>Haapala, I</creatorcontrib><creatorcontrib>Haapasalo, J</creatorcontrib><creatorcontrib>Vik-Mo, E</creatorcontrib><creatorcontrib>Puustinen, S</creatorcontrib><title>P14.15.A INTRAOPERATIVE ASPIRATE TISSUE MONITORING DURING 5-ALA GUIDED HIGH-GRADE GLIOMA SURGERY</title><title>Neuro-oncology (Charlottesville, Va.)</title><description>Abstract BACKGROUND The first-line treatment for high-grade gliomas (HGG) is maximal safe resection, which is limited by diffuse tumor margins and nearby eloquent areas. Intraoperative detection of tumor cells is improved with fluorescence-guided surgery using 5-ALA, but its visual detection is limited by blood, obstacles and weakness of the fluorescence. Aspirate tissue monitoring (ATM) of fluorescence from surgical suction waste could improve surgical performance by providing objective feedback while maintaining a natural white light anatomical view. This observational study compared the visual detection of 5-ALA fluorescence to feedback from an ATM device. MATERIALS AND METHODS Twelve (n=12) patients’ suspected HGG resection with (n=9) and without (n=3) prescribed 5-ALA were recorded while a prototype ATM, was attached to the tube of an ultrasonic aspirator. Seven (7) neurosurgeons viewed the white and blue light operation videos with and without ATM feedback and responded to a questionnaire assessing the safety and benefit-risk ratio of ATM. According to the averaged experts’ analysis, the resected tissues were categorized to visually perceivable fluorescence (yes/no) and compared to the ATM signals. RESULTS In total 42 video sequences were analyzed. The sensitivity and specificity of ATM in comparison to visual analysis was 100% and 80%, respectively. The positive predictive value (PPV) of ATM was 92% and the negative predictive value (NPV) was 100%. The ATM detected fluorescence under white light in 11 of the resected areas, whereas experts in 0 areas (p&lt;0.001). 10/11 of these areas were verified to include strong visual fluorescence under blue light according to experts’ analysis. The neurosurgeons agreed that ATM appears safe and adds value to contemporary navigation techniques with good agreement (averaged overall agreement rate = 96,7%). CONCLUSIONS The ATM improved intraoperative detection of fluorescence compared to visual analysis. 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Intraoperative detection of tumor cells is improved with fluorescence-guided surgery using 5-ALA, but its visual detection is limited by blood, obstacles and weakness of the fluorescence. Aspirate tissue monitoring (ATM) of fluorescence from surgical suction waste could improve surgical performance by providing objective feedback while maintaining a natural white light anatomical view. This observational study compared the visual detection of 5-ALA fluorescence to feedback from an ATM device. MATERIALS AND METHODS Twelve (n=12) patients’ suspected HGG resection with (n=9) and without (n=3) prescribed 5-ALA were recorded while a prototype ATM, was attached to the tube of an ultrasonic aspirator. Seven (7) neurosurgeons viewed the white and blue light operation videos with and without ATM feedback and responded to a questionnaire assessing the safety and benefit-risk ratio of ATM. According to the averaged experts’ analysis, the resected tissues were categorized to visually perceivable fluorescence (yes/no) and compared to the ATM signals. RESULTS In total 42 video sequences were analyzed. The sensitivity and specificity of ATM in comparison to visual analysis was 100% and 80%, respectively. The positive predictive value (PPV) of ATM was 92% and the negative predictive value (NPV) was 100%. The ATM detected fluorescence under white light in 11 of the resected areas, whereas experts in 0 areas (p&lt;0.001). 10/11 of these areas were verified to include strong visual fluorescence under blue light according to experts’ analysis. The neurosurgeons agreed that ATM appears safe and adds value to contemporary navigation techniques with good agreement (averaged overall agreement rate = 96,7%). CONCLUSIONS The ATM improved intraoperative detection of fluorescence compared to visual analysis. The safety and benefit-risk assessment depicts non-inferiority compared to visual analysis for detecting fluorescence during HGG surgery.</abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/neuonc/noae144.266</doi></addata></record>
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title P14.15.A INTRAOPERATIVE ASPIRATE TISSUE MONITORING DURING 5-ALA GUIDED HIGH-GRADE GLIOMA SURGERY
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