St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
J Neurosurg. 2012 Apr;116(4):854-60. doi: 10.3171/2011.12.JNS11696. Epub 2012 Jan 27.
Frozen-section analysis is the current standard for the intraoperative diagnosis of brain tumors. Intraoperative confocal microscopy is an emerging technology with the potential to visualize tumor histopathological features and cell morphology in real time. The authors report their findings using this new intraoperative technology in vivo with sodium fluorescein contrast during the course of 50 microsurgical tumor resections.
Eighty-eight regions were visualized with confocal microscopy, and corresponding biopsy samples were examined with routine neuropathological analysis. The tumors studied included meningiomas, schwannomas, gliomas of various grades, and a hemangioblastoma. The confocal microscopic features of each tumor and of various artifacts inherent to the technology were documented. A pathologist working in a blinded fashion reviewed a subset of the images in a further evaluation of the usefulness of the device as a diagnostic tool.
Overall, intraoperative confocal imaging correlated surprisingly well with corresponding traditional histological findings, including the identification of many pathognomonic cytoarchitectural features of various brain tumors. In the blinded study, 26 (92.9%) of 28 lesions were diagnosed correctly.
Further study will be necessary for better definition of the role of intraoperative confocal microscopy as a routine adjunct for intraoperative brain tumor diagnosis.
冰冻切片分析是目前脑肿瘤术中诊断的标准方法。术中共聚焦显微镜是一种新兴技术，具有实时可视化肿瘤组织病理学特征和细胞形态的潜力。作者报告了他们在 50 例显微肿瘤切除术中使用这种新的术中技术的发现，术中使用荧光素钠作为对比。
使用共聚焦显微镜观察了 88 个区域，并对相应的活检样本进行了常规神经病理学分析。研究的肿瘤包括脑膜瘤、神经鞘瘤、各种分级的胶质瘤和血管母细胞瘤。记录了每种肿瘤的共聚焦显微镜特征以及该技术固有的各种伪影。一名病理学家在盲法的情况下对部分图像进行了回顾，以进一步评估该设备作为诊断工具的有用性。
总的来说，术中共聚焦成像与传统的组织学发现非常吻合，包括识别出各种脑肿瘤的许多特征性细胞结构特征。在盲法研究中，28 个病变中有 26 个（92.9%）得到了正确诊断。
需要进一步研究以更好地确定术中共聚焦显微镜作为术中脑肿瘤诊断常规辅助手段的作用。
