Herbert Stepp,1 Wolfgang Beyer,1 David Brucker,1 Andre Ehrhardt,2 Stefan Fischer,3 Werner Goebel,2 Marcus Goetz,3 Bettina Guenther,1 Georg Hennig,1 Jochen Herms,1 Klaus-Martin Irion,2 Ann Johansson,1 Yvonne Kienast,1 Gesa Kniebuehler,1 Pan Li,3 Adrian Ruehm,1 Sabine Sandner1
1Ludwig-Maximilians-Univ. München (Germany) 2Karl Storz GmbH & Co KG (Germany) 3MRC Systems GmbH (Germany)
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Objective: When a stereotactic biopsy is taken to enable histopathological diagnosis of a suspected brain tumor, it is
essential to i) do this safely, that is not injure a major blood vessel and ii) to obtain relevant vital material from the
tumor. We are investigating the suitability of Indocyanine Green (ICG) fluorescence for blood vessel recognition and 5-
Aminolevulinic acid (5-ALA) induced Protoporphyrin IX (PpIX) fluorescence for identification of proliferative brain
tumor tissue.
Methods: A fiber-optic endoscopic approach was studied to generate and detect both fluorescence signals. PpIX
concentrations in brain tumors have been measured by chemical extraction. Preliminary equipment was studied in a
mouse model.
Results: PpIX-concentrations in glioblastoma tissue showed high inner- and inter-patient variability, but each patient
out of 15 with interpretable data showed at least one sample with a PpIX-concentration exceeding 2.4 μmol/l, which is
easily detectable by state-of-the-art fiberoptic fluorescence spectroscopy and imaging. The imaging fluoroscope with
30,000 pixels resolution could be introduced through a position controlled stereotactic needle. ICG-fluorescence from
vessels with diameters ≥ 0.1 mm can be detected with a contrast of 2-2.5 against surrounding tissue.
Conclusion: Fluorescence detection during stereotactic biopsy might increase safety and precision of the procedure
significantly.
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Herbert Stepp, Wolfgang Beyer, David Brucker, Andre Ehrhardt, Stefan Fischer, Werner Goebel, Marcus Goetz, Bettina Guenther, Georg Hennig, Jochen Herms, Klaus-Martin Irion, Ann Johansson, Yvonne Kienast, Gesa Kniebuehler, Pan Li, Adrian Ruehm, Sabine Sandner, "Fluorescence guidance during stereotactic biopsy," Proc. SPIE 8207, Photonic Therapeutics and Diagnostics VIII, 82074H (17 February 2012); https://doi.org/10.1117/12.915751