title: Prospective evaluation of the utility of intraoperative confocal laser endomicroscopy in patients with brain neoplasms using fluorescein sodium: experience with 74 cases.
abstract: OBJECTIVE
  This study evaluated the utility, specificity, and sensitivity of intraoperative confocal laser endomicroscopy (CLE) to provide diagnostic information during resection of human brain tumors.
  
  
  METHODS
  CLE imaging was used in the resection of intracranial neoplasms in 74 consecutive patients (31 male; mean age 47.5 years; sequential 10-month study period). Intraoperative in vivo and ex vivo CLE was performed after intravenous injection of fluorescein sodium (FNa). Tissue samples from CLE imaging-matched areas were acquired for comparison with routine histological analysis (frozen and permanent sections). CLE images were classified as diagnostic or nondiagnostic. The specificities and sensitivities of CLE and frozen sections for gliomas and meningiomas were calculated using permanent histological sections as the standard.
  
  
  RESULTS
  CLE images were obtained for each patient. The mean duration of intraoperative CLE system use was 15.7 minutes (range 3-73 minutes). A total of 20,734 CLE images were correlated with 267 biopsy specimens (mean number of images/biopsy location, in vivo 84, ex vivo 70). CLE images were diagnostic for 45.98% in vivo and 52.97% ex vivo specimens. After initiation of CLE, an average of 14 in vivo images and 7 ex vivo images were acquired before identification of a first diagnostic image. CLE specificity and sensitivity were, respectively, 94% and 91% for gliomas and 93% and 97% for meningiomas.
  
  
  CONCLUSIONS
  CLE with FNa provided intraoperative histological information during brain tumor removal. Specificities and sensitivities of CLE for gliomas and meningiomas were comparable to those for frozen sections. These data suggest that CLE could allow the interactive identification of tumor areas, substantially improving intraoperative decisions during the resection of brain tumors.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Nikolay L
authors.initials: NL
authors.lastname: Martirosyan
authors.affiliation: Neuropathology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Eschbacher
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: M Yashar S
authors.initials: MY
authors.lastname: Kalani
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Turner
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Evgenii
authors.initials: E
authors.lastname: Belykh
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Preul
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D019793:Fluorescein / Q000008:administration & dosage; D005456:Fluorescent Dyes / Q000008:administration & dosage; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods* / Q000706:statistics & numerical data*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D005456:Fluorescent Dyes; D019793:Fluorescein
keywords: CLE = confocal laser endomicroscopy; FN = false negative; FNa = fluorescein sodium; FP = false positive; H & E = hematoxylin and eosin; TN = true negative; TP = true positive; WHO = World Health Organization; confocal laser endomicroscopy; fluorescein sodium; frozen section; intracranial neoplasms; tumor fluorescence