Protoporphyrin-IX fluorescence guided surgical resection in high-grade gliomas: the potential impact of human colour perception

Max Petterssen, Sarah Eljamel, Sam Eljamel (Lead / Corresponding author)

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    Introduction: Protoporphyrin-IX (Pp-IX) fluorescence had been used frequently in recent years to guide microsurgical resection of high-grade gliomas (HGG), particularly following the publication of a randomized controlled trial demonstrating its advantages. However, Pp-IX fluorescence is dependent upon the surgeons' eyes' perception of red fluorescent colour. This study was designed to evaluate human eye fluorescence perception and establish a fluorescence scale.
    Materials and methods: 20 of 108 pre-recorded images from intraoperative fluorescence of HGG were used to construct an 8-panel visual analogue fluorescence scale. The scale was validated by testing 56 participants with normal colour vision and three red-green colour-blind participants. For intra-rater agreement ten participants were tested twice and for inter-observer reliability the whole cohort were tested.
    Results: The intra- and inter-observer reliability of the scale in normal colour vision participants was excellent. The scale was less reliable in the violet-blue panels of the scale. Colour-blind participants were not able to distinguish between red fluorescence and blue-violet colours.
    Conclusion: The 8-panel fluorescence scale is valid in differentiating red, pink and blue colours in a fluorescence surgical field among participants with normal colour perception and potentially useful to standardize fluorescence-guided surgery. However, colourblind surgeons should not use fluorescence-guided surgery.
    Original languageEnglish
    Pages (from-to)351-356
    Number of pages6
    JournalPhotodiagnosis and Photodynamic Therapy
    Issue number3
    Publication statusPublished - Sept 2014


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