Confocal scanning microscopy provides rapid, detailed intraoperative histological assessment of brain neoplasms: Experience with 106 cases

Authors

Nikolay L. Martirosyan, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA; Division of Neurosurgery, University of Arizona, Tucson, AZ, USA.Follow
Joseph Georges, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA.
Jennifer M. Eschbacher, Division of Neuropathology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA.Follow
Evgenii Belykh, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA; Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.Follow
Alessandro Carotenuto, College of Medicine, University of Arizona, Tucson, AZ, USA.
Robert F. Spetzler, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA.
Peter Nakaji, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA.
Mark C. Preul, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA. Electronic address: neuropub@dignityhealth.edu.

Document Type

Article

Abstract

OBJECTIVES: Frozen section histological analysis is currently the mainstay for intraprocedural tissue diagnosis during the resection of intracranial neoplasms and for evaluating tumor margins. However, frozen sections are time-consuming and often do not reveal the histological features needed for final diagnosis when compared with permanent sections. Confocal scanning microscopy (CSM) with certain stains may be a valuable technology that can add rapid and detailed histological assessment advantage for the neurosurgical operating room. This study describes potential advantages of CSM imaging of fresh human brain tumor tissues labeled with acriflavine (AF), acridine orange (AO), cresyl violet (CV), methylene blue (MB), and indocyanine green (ICG) within the neurosurgical operating room facility. PATIENTS AND METHODS: Acute slices from orthotopic human intracranial neoplasms were incubated with AF/AO and CV solutions for 10 s and 1 min respectively. Staining was also attempted with MB and ICG. Samples were imaged using a bench-top CSM system. Histopathologic features of corresponding CSM and permanent hematoxylin and eosin images were reviewed for each case. RESULTS: Of 106 cases, 30 were meningiomas, 19 gliomas, 13 pituitary adenomas, 9 metastases, 6 schwannomas, 4 ependymomas, and 25 other pathologies. CSM using rapid fluorophores (AF, AO, CV) revealed striking microvascular, cellular and subcellular structures that correlated with conventional histology. By rapidly staining and optically sectioning freshly resected tissue, images were generated for intraoperative consultations in less than one minute. With this technique, an entire resected tissue sample was imaged and digitally stored for tele-pathology and archiving. CONCLUSION: CSM of fresh human brain tumor tissue provides clinically meaningful and rapid histopathological assessment much faster than frozen section. With appropriate stains, including specific cellular structure or antibody staining, CSM could improve the timeliness of intraoperative decision-making, and the neurosurgical-pathology workflow during resection of human brain tumors, ultimately improving patient care.

Medical Subject Headings

Adolescent; Adult; Aged; Aged, 80 and over; Biopsy (methods); Brain Neoplasms (pathology, surgery); Female; Fluorescent Dyes (analysis); Humans; Male; Microscopy, Confocal (methods); Microsurgery (methods); Middle Aged; Monitoring, Intraoperative (methods); Prospective Studies; Time Factors; Young Adult

Publication Date

6-1-2018

Publication Title

Clinical neurology and neurosurgery

E-ISSN

1872-6968

Volume

169

First Page

21

Last Page

28

PubMed ID

29604507

Digital Object Identifier (DOI)

10.1016/j.clineuro.2018.03.015

Recommended Citation

Martirosyan, Nikolay L.; Georges, Joseph; Eschbacher, Jennifer M.; Belykh, Evgenii; Carotenuto, Alessandro; Spetzler, Robert F.; Nakaji, Peter; and Preul, Mark C., "Confocal scanning microscopy provides rapid, detailed intraoperative histological assessment of brain neoplasms: Experience with 106 cases" (2018). Neurosurgery. 1676.
https://scholar.barrowneuro.org/neurosurgery/1676