PMID- 29604507 OWN - NLM STAT- MEDLINE DCOM- 20190906 LR - 20190906 IS - 1872-6968 (Electronic) IS - 0303-8467 (Linking) VI - 169 DP - 2018 Jun TI - Confocal scanning microscopy provides rapid, detailed intraoperative histological assessment of brain neoplasms: Experience with 106 cases. PG - 21-28 LID - S0303-8467(18)30118-5 [pii] LID - 10.1016/j.clineuro.2018.03.015 [doi] AB - 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. CI - Copyright (c) 2018 Elsevier B.V. All rights reserved. FAU - Martirosyan, Nikolay L AU - Martirosyan NL AD - 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. FAU - Georges, Joseph AU - Georges J AD - Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA. FAU - Eschbacher, Jennifer M AU - Eschbacher JM AD - Division of Neuropathology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA. FAU - Belykh, Evgenii AU - Belykh E AD - 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. FAU - Carotenuto, Alessandro AU - Carotenuto A AD - College of Medicine, University of Arizona, Tucson, AZ, USA. FAU - Spetzler, Robert F AU - Spetzler RF AD - Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA. FAU - Nakaji, Peter AU - Nakaji P AD - Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA. FAU - Preul, Mark C AU - Preul MC AD - Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA. Electronic address: neuropub@dignityhealth.edu. LA - eng PT - Journal Article DEP - 20180321 PL - Netherlands TA - Clin Neurol Neurosurg JT - Clinical neurology and neurosurgery JID - 7502039 RN - 0 (Fluorescent Dyes) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Biopsy/methods MH - Brain Neoplasms/*pathology/*surgery MH - Female MH - *Fluorescent Dyes/analysis MH - Humans MH - Male MH - Microscopy, Confocal/methods MH - Microsurgery/*methods MH - Middle Aged MH - Monitoring, Intraoperative/*methods MH - Prospective Studies MH - Time Factors MH - Young Adult OTO - NOTNLM OT - Acridine orange OT - Acriflavine OT - Brain tumor OT - Confocal scanning microscopy OT - Cresyl violet OT - Frozen section OT - Intracranial neoplasms OT - Tumor fluorescence EDAT- 2018/04/01 06:00 MHDA- 2019/09/07 06:00 CRDT- 2018/04/01 06:00 PHST- 2018/01/04 00:00 [received] PHST- 2018/03/12 00:00 [revised] PHST- 2018/03/17 00:00 [accepted] PHST- 2018/04/01 06:00 [pubmed] PHST- 2019/09/07 06:00 [medline] PHST- 2018/04/01 06:00 [entrez] AID - S0303-8467(18)30118-5 [pii] AID - 10.1016/j.clineuro.2018.03.015 [doi] PST - ppublish SO - Clin Neurol Neurosurg. 2018 Jun;169:21-28. doi: 10.1016/j.clineuro.2018.03.015. Epub 2018 Mar 21.