title: Intraoperative optical spectroscopy identifies infiltrating glioma margins with high sensitivity.
abstract: OBJECTIVE
  Adult gliomas have indistinct borders. As the ratio of neoplastic cells to normal cells becomes lower, the ability to detect these cells diminishes. We describe a device designed to augment intraoperative identification of both solid tumor and infiltrating tumor margins.
  
  
  METHODS
  A novel, intraoperative, optical spectroscopic tool, using both white light reflectance and 337-nm excitation fluorescence spectroscopy, is described. Discrimination algorithms have been developed to segregate neoplastic tissues from normal glial and neuronal elements. The spectroscopy device was used to measure 5 to 10 locations during glioma resection. Beneath the tool, a biopsy sample was obtained and the pathological results were reviewed in a blinded fashion. Samples were classified as solid tumor, infiltrating tumor, or normal gray or white matter. Comparisons were made between the optical spectra and the histopathological results of sampled areas in evaluating the sensitivity and specificity of the tool for tissue discrimination.
  
  
  RESULTS
  Spectral data were obtained from 24 patients with glioma and from 11 patients with temporal lobe epilepsy. A sensitivity of 80% and a specificity of 89% in discriminating solid tumor from normal tissues were obtained. In addition, infiltrating tumor margins were distinguished from normal tissues with a sensitivity of 94% and a specificity of 93%.
  
  
  CONCLUSIONS
  We have developed a handheld, optical spectroscopic device that may be used rapidly and in near real time with high sensitivity and reproducibility as an optical tissue discrimination tool in glioma surgery.
authors.affiliation: Brain Tumor Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. tomss@ccf.org
authors.forename: Steven A
authors.initials: SA
authors.lastname: Toms
authors.forename: Wei-Chiang
authors.initials: WC
authors.lastname: Lin
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
authors.forename: Mahlon D
authors.initials: MD
authors.lastname: Johnson
authors.forename: E Duco
authors.initials: ED
authors.lastname: Jansen
authors.forename: Anita
authors.initials: A
authors.lastname: Mahadevan-Jansen