17 February 2012 Fluorescence guidance during stereotactic biopsy
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Objective: When a stereotactic biopsy is taken to enable histopathological diagnosis of a suspected brain tumor, it is essential to i) do this safely, that is not injure a major blood vessel and ii) to obtain relevant vital material from the tumor. We are investigating the suitability of Indocyanine Green (ICG) fluorescence for blood vessel recognition and 5- Aminolevulinic acid (5-ALA) induced Protoporphyrin IX (PpIX) fluorescence for identification of proliferative brain tumor tissue. Methods: A fiber-optic endoscopic approach was studied to generate and detect both fluorescence signals. PpIX concentrations in brain tumors have been measured by chemical extraction. Preliminary equipment was studied in a mouse model. Results: PpIX-concentrations in glioblastoma tissue showed high inner- and inter-patient variability, but each patient out of 15 with interpretable data showed at least one sample with a PpIX-concentration exceeding 2.4 μmol/l, which is easily detectable by state-of-the-art fiberoptic fluorescence spectroscopy and imaging. The imaging fluoroscope with 30,000 pixels resolution could be introduced through a position controlled stereotactic needle. ICG-fluorescence from vessels with diameters ≥ 0.1 mm can be detected with a contrast of 2-2.5 against surrounding tissue. Conclusion: Fluorescence detection during stereotactic biopsy might increase safety and precision of the procedure significantly.
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Herbert Stepp, Herbert Stepp, Wolfgang Beyer, Wolfgang Beyer, David Brucker, David Brucker, Andre Ehrhardt, Andre Ehrhardt, Stefan Fischer, Stefan Fischer, Werner Goebel, Werner Goebel, Marcus Goetz, Marcus Goetz, Bettina Guenther, Bettina Guenther, Georg Hennig, Georg Hennig, Jochen Herms, Jochen Herms, Klaus-Martin Irion, Klaus-Martin Irion, Ann Johansson, Ann Johansson, Yvonne Kienast, Yvonne Kienast, Gesa Kniebuehler, Gesa Kniebuehler, Pan Li, Pan Li, Adrian Ruehm, Adrian Ruehm, Sabine Sandner, Sabine Sandner, } "Fluorescence guidance during stereotactic biopsy", Proc. SPIE 8207, Photonic Therapeutics and Diagnostics VIII, 82074H (17 February 2012); doi: 10.1117/12.915751; https://doi.org/10.1117/12.915751

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