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Ex-Vivo Evaluation of a Novel Miniaturized Epi-Fluorescent Widefield Microscope in Intra-Operative Differentiation between Central Nervous System Lesions and Normal Tissues
24 Pages Posted: 11 Jul 2024
More...Abstract
Objective: Intra-operative pathological examination has been proven to assist in increasing the extent of resection and benefit overall survival in patients with brain tumors. This study evaluates the effectiveness of the miniaturized epi-fluorescent widefield microscope (MEW-M) system in intra-operative differentiation of intra-cranial lesions from normal brain tissue.
Methods: 16 patients were prospectively enrolled. Biopsies were taken from boundary tissues and divided into two groups: observation by MEW-M and frozen and paraffin- embedded section pathology by neurosurgeons and neuropathologists. Diagnoses were made by hematoxylin-eosin staining of paraffin sections. Images and procedure duration were recorded, and the accuracy of diagnosis was compared between MEW-M and frozen section pathology.
Results: A total of 52 tissues were examined. The morphology of vessels, cells, nuclei and other subcellular structures were clearly identified using MEW-M. In malignant tumors, the MEW-M had a sensitivity of 0.91, specificity of 1.00 and an area under the curve (AUC) value of 0.95 when compared with HE stain. The kappa value between MEW-M and HE stain examination for malignant tumors was 0.81. In this study, MEW-M took up an average of 4.98 minutes to diagnose, which was significantly shorter than frozen section pathology (4.98[[EQUATION]]1.31 v.s. 28.15[[EQUATION]]4.04 minutes, p value<2.2e-16).
Conclusions: In this study, we firstly showed a comparable sensitivity and specificity between MEW-M and intra-operative frozen section pathology in CNS tumors. MEW-M has the potential to differentiate margins of CNS lesions intra-operatively in a simpler and faster way of use. However, efficacy should be evaluated in a larger population.
Funding: This work was funded by CAMS Innovation Fund for Medical Sciences (2021-I2M-1-014), the National High Level Hospital Clinical Research Funding (2022-PUMCH-A-019) for Yu Wang, and the National High Level Hospital Clinical Research Funding (2022-PUMCH-B-113), the Tsinghua University-Peking Union Medical College Hospital Initiative Scientific Research Program (2019ZLH101) and the Beijing Municipal Natural Science Foundation (19JCZDJC64200[Z]) for Wenbin Ma.
Declaration of Interest: We, as all author of “EX Vivo Evaluation of a Novel Miniaturized Epi-fluorescent Widefield Microscope in Intra-operative Differentiation Between Central Nervous System Lesions and Normal Tissues”, state that there is no Conflict of Interest.
Ethical Approval: Our study was approved by the Institutional Review Board of Peking Union Medical College Hospital, China and signed informed consent was obtained from all patients.
Keywords: Miniaturized Epi-fluorescent Widefield Microscope, Central Nervous System Tumor, Resection Margins, Pathological Diagnosis, Glioma
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