Kuppler Patrick, Strenge Paul, Lange Birgit, Spahr-Hess Sonja, Draxinger Wolfgang, Hagel Christian, Theisen-Kunde Dirk, Brinkmann Ralf, Huber Robert, Tronnier Volker, Bonsanto Matteo Mario
Department of Neurosurgery, University Medical Center Schleswig-Holstein, Luebeck, Germany.
Medical Laser Center Luebeck, Luebeck, Germany.
Front Oncol. 2023 Apr 13;13:1151149. doi: 10.3389/fonc.2023.1151149. eCollection 2023.
In brain tumor surgery, it is crucial to achieve complete tumor resection while conserving adjacent noncancerous brain tissue. Several groups have demonstrated that optical coherence tomography (OCT) has the potential of identifying tumorous brain tissue. However, there is little evidence on human application of this technology, especially regarding applicability and accuracy of residual tumor detection (RTD). In this study, we execute a systematic analysis of a microscope integrated OCT-system for this purpose.
Multiple 3-dimensional OCT-scans were taken at protocol-defined sites at the resection edge in 21 brain tumor patients. The system was evaluated for its intraoperative applicability. Tissue biopsies were obtained at these locations, labeled by a neuropathologist and used as ground truth for further analysis. OCT-scans were visually assessed with a qualitative classifier, optical OCT-properties were obtained and two artificial intelligence (AI)-assisted methods were used for automated scan classification. All approaches were investigated for accuracy of RTD and compared to common techniques.
Visual OCT-scan classification correlated well with histopathological findings. Classification with measured OCT image-properties achieved a balanced accuracy of 85%. A neuronal network approach for scan feature recognition achieved 82% and an auto-encoder approach 85% balanced accuracy. Overall applicability showed need for improvement.
Contactless OCT scanning has shown to achieve high values of accuracy for RTD, supporting what has well been described for ex vivo OCT brain tumor scanning, complementing current intraoperative techniques and even exceeding them in accuracy, while not yet in applicability.
在脑肿瘤手术中，在保留相邻非癌脑组织的同时实现肿瘤的完全切除至关重要。多个研究小组已证明光学相干断层扫描（OCT）有识别脑肿瘤组织的潜力。然而，关于该技术在人体中的应用，尤其是在残余肿瘤检测（RTD）的适用性和准确性方面，证据很少。在本研究中，我们为此对一种集成在显微镜上的OCT系统进行了系统分析。
对21例脑肿瘤患者在切除边缘按方案定义的部位进行多次三维OCT扫描。评估该系统在术中的适用性。在这些部位获取组织活检样本，由神经病理学家进行标记，并用作进一步分析的金标准。使用定性分类器对OCT扫描进行视觉评估，获取光学OCT特性，并使用两种人工智能（AI）辅助方法进行自动扫描分类。研究所有方法的RTD准确性，并与常用技术进行比较。
OCT扫描的视觉分类与组织病理学结果相关性良好。根据测量的OCT图像特性进行分类，平衡准确率达到85%。一种用于扫描特征识别的神经网络方法准确率为82%，自动编码器方法的平衡准确率为85%。总体适用性有待提高。
非接触式OCT扫描已显示出在RTD方面具有较高的准确性，支持了此前对离体OCT脑肿瘤扫描的描述，补充了当前的术中技术，甚至在准确性上超过了它们，不过在适用性方面尚未达到。
