Intra-operative Guidance of Brain Tumor Surgery

utilizing quantitative OCT imaging technology for differentiation of cancerous vs normal brain tissues via absorption properties

Introduction:

The ultimate goal of brain cancer surgery is to maximize the extent of resection (EOR) without compromising brain function, since maximal EOR is positively associated with improved patient survival. Our project uses a high-speed/resolution hand-held optical coherence tomography (OCT) handheld imaging probe to pinpoint and identify tumor margins in real-time, with the goal of achieving excellent sensitivity and specificity.

Motivation:

In brain cancers such as gliomas, aggressive removal of the solid tumor through surgery is associated with improved patient outcome. At least 78% of the tumor has to be removed to make a meaningful difference in the patient’s survival. Current techniques for tumor removal are limited in their ability to safely and accurately identify tumor versus non-tumor tissues and provide continuous guidance in real-time. The objective of this work is to develop, test, and validate the ability OCT imaging to detect brain cancer tissues with very high precision. This distinction of tumor tissues is especially important at the infiltrative, transitional zones between tumor and non-tumor, which are difficult to identify intra-operatively.

Project Overview:

We have studied tissue characteristics of the ex vivo tumor and non-tumor brain tissues obtained from glioma patients, and tested the performance of the real-time OCT handheld probe within an intraoperative setting by surgical debulking of implanted brain tumors in small animal models. We are planning pilot clinical studies in the operating room.

Potential Impact:

This study will potentially maximize the EOR of infiltrative tumors and thereby increase overall survival of patients. The OCT technique may also be applied to a variety of other central nervous system (CNS) tumors when tumor margins are not well defined.

Figure 1. Swept-source optical coherence tomography (SS-OCT) system. (Click to view detailed caption)

Figure 2. En face attenuation results of a high-grade brain cancer tissue block (2mm x 2mm x 1.8mm) are shown with corresponding histology. (Click to view detailed caption)

Figure 3. In vivo brain cancer imaging in a mouse with patient-derived high-grade brain cancer (GBM272). (Click to view detailed caption)

Reference

  1. C. Kut, K. L. Chaichana, J. F. Xi, S. M. Raza, X. Ye, E. R. McVeigh, F. J. Rodriguez, A. Quiñones-Hinojosa, X. D. Li. "Detection of human brain cancer infiltration ex vivo and in vivo using quantitative optical coherence tomography," Science Translational Medicine 7 292, pp. 292ra100 (2015).


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