Table_1_The neurosurgical benefit of contactless in vivo optical coherence tomography regarding residual tumor detection: A clinical study.docx

PurposeIn brain tumor surgery, it is crucial to achieve complete tumor resection while conserving adjacent noncancerous brain tissue. Several groups have demonstrated that optical coherence tomography (OCT) has the potential of identifying tumorous brain tissue. However, there is little evidence on human in vivo application of this technology, especially regarding applicability and accuracy of residual tumor detection (RTD). In this study, we execute a systematic analysis of a microscope integrated OCT-system for this purpose.
Experimental designMultiple 3-dimensional in vivo OCT-scans were taken at protocol-defined sites at the resection edge in 21 brain tumor patients. The system was evaluated for its intraoperative applicability. Tissue biopsies were obtained at these locations, labeled by a neuropathologist and used as ground truth for further analysis. OCT-scans were visually assessed with a qualitative classifier, optical OCT-properties were obtained and two artificial intelligence (AI)-assisted methods were used for automated scan classification. All approaches were investigated for accuracy of RTD and compared to common techniques.
ResultsVisual OCT-scan classification correlated well with histopathological findings. Classification with measured OCT image-properties achieved a balanced accuracy of 85%. A neuronal network approach for scan feature recognition achieved 82% and an auto-encoder approach 85% balanced accuracy. Overall applicability showed need for improvement.
ConclusionContactless in vivo OCT scanning has shown to achieve high values of accuracy for RTD, supporting what has well been described for ex vivo OCT brain tumor scanning, complementing current intraoperative techniques and even exceeding them in accuracy, while not yet in applicability.

【研究目的】脑肿瘤手术的核心目标在于实现肿瘤的完整切除，同时最大程度保留毗邻的非癌性脑组织。已有多项研究证实，光学相干断层扫描（optical coherence tomography, OCT）具备识别肿瘤性脑组织的潜力。但目前关于该技术在人体体内（in vivo）应用的相关证据仍较为匮乏，尤其是在残留肿瘤检测（residual tumor detection, RTD）的适用性与准确性方面。本研究针对一款显微镜集成光学相干断层扫描系统，开展系统性分析以实现上述目标。
【实验设计】本研究纳入21例脑肿瘤患者，在手术切除边缘按照试验方案预设的点位采集多组三维体内（in vivo）OCT扫描数据。研究对该系统的术中适用性进行评估。于上述点位获取组织活检样本，由神经病理学家进行标注并作为后续分析的金标准（ground truth）。采用定性分类器对OCT扫描图像进行视觉评估，提取OCT光学特征，并使用两种人工智能（artificial intelligence, AI）辅助方法实现扫描图像的自动化分类。对所有方法的残留肿瘤检测准确性进行验证，并与现有常规技术开展对比。
【研究结果】视觉评估的OCT扫描分类结果与组织病理学检测结果具有良好的相关性。基于提取的OCT图像特征开展分类的方法，其平衡准确率可达85%。采用神经网络进行扫描特征识别的方法准确率为82%，而自编码器方法的平衡准确率可达85%。整体而言，该系统的适用性仍有待提升。
【研究结论】非接触式体内（in vivo）OCT扫描在残留肿瘤检测中展现出较高的准确性，这一结果验证了此前体外（ex vivo）OCT脑肿瘤扫描的相关研究结论。该技术可作为现有术中诊疗技术的补充，在准确性上甚至优于现有常规手段，但在适用性方面仍存在改进空间。