Lisanne Kraft

Silvia Noble Anbunesan, Mohamed Abul Hassan, Jinyi Qi et al.

Accurate intraoperative assessment of glioma infiltration is essential for maximizing tumor resection while preserving functional brain tissue. Fluorescence lifetime imaging (FLIm) offers real-time, label-free biochemical contrast, but its clinical utility is challenged by biological heterogeneity, class imbalance, and variability in histopathological labeling. We present a data-centric AI (DC-AI) framework that integrates confident learning (CL), class refinement, and targeted label evaluation to develop a robust multi-class FLIm classifier for glioblastoma (GBM) resection margins. FLIm data were collected from 192 tissue margins across 31 newly diagnosed IDH-wildtype GBM patients and initially labeled into seven tumor cellularity classes by an expert neuropathologist. CL was applied to quantify FLIm point-level confidence, identify label inconsistencies, and guide iterative class merging into a three-class scheme ("low", "moderate", "high"). The resulting high-fidelity dataset enabled training a model that achieved 96% accuracy in the three-class task. SHAP analysis revealed class-specific FLIm feature importance, highlighting distinct optical signatures across the infiltration spectrum. Targeted FLIm analysis further identified biological (e.g., gray matter composition) and acquisition-related (e.g., blood contamination) contributors to low-confidence predictions. Blinded re-evaluation of margins flagged by CL demonstrated intra-pathologist variability, underscoring the value of selective relabeling rather than exhaustive review. Together, these findings demonstrate that a DC-AI framework can systematically improve data reliability, enhance model robustness, and refine biological interpretation of FLIm signals, supporting the development of clinically actionable optical tools for real-time glioma margin assessment.

Mohamed Abul Hassan, Pu Sun, Xiangnan Zhou et al.

This study introduces a novel data-centric approach to improve real-time surgical guidance using fiber-based fluorescence lifetime imaging (FLIm). A key aspect of the methodology is the accurate detection of the aiming beam, which is essential for localizing points used to map FLIm measurements onto the tissue region within the surgical field. The primary challenge arises from the complex and variable conditions encountered in the surgical environment, particularly in Transoral Robotic Surgery (TORS). Uneven illumination in the surgical field can cause reflections, reduce contrast, and results in inconsistent color representation, further complicating aiming beam detection. To overcome these challenges, an instance segmentation model was developed using a data-centric training strategy that improves accuracy by minimizing label noise and enhancing detection robustness. The model was evaluated on a dataset comprising 40 in vivo surgical videos, demonstrating a median detection rate of 85%. This performance was maintained when the model was integrated in a clinical system, achieving a similar detection rate of 85% during TORS procedures conducted in patients. The system's computational efficiency, measured at approximately 24 frames per second (FPS), was sufficient for real-time surgical guidance. This study enhances the reliability of FLIm-based aiming beam detection in complex surgical environments, advancing the feasibility of real-time, image-guided interventions for improved surgical precision