Article
Diagnostic yield of 5-ALA-fluorescence in stereotactic biopsies of intracerebral lesions: a prospective study
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Authors
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Vesna Malinova
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Timo Behm
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Kajetan von Eckardstein
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Stereotactic biopsies are routinely used to establish a histological diagnosis of inoperable intracerebral tumors and other pathologies. Intraoperatively frozen section analysis often confirms diagnostic tissue, but has a limited diagnostic accuracy due to methodological pitfalls. 5-ALA-fluorescence has been described not only in gliomas but also in metastases and lymphomas. The aim of this study was to evaluate the value of 5-ALA-fluorescence for intraoperative confirmation of diagnostic tissue in stereotactic biopsy procedures of unclear intracerebral pathologies.
Methods: Patients scheduled for stereotactic biopsies of unclear intracerebral pathologies received 5-ALA preoperatively. Obtained samples were intraoperatively analyzed for presence of 5-ALA-fluorescence. One sample was used for frozen section and a second one for permanent histopathological analysis. The diagnostic accuracy was than correlated with intraoperative 5-ALA-fluorenscence.
Results: A total of 23 patients with 46 obtained tissue samples were prospectively included in the study. In 79% (18/23) of patients 5-ALA-fluorescence was positive. All samples with 5-ALA-fluorescence were of diagnostic tissue. The histological findings of specimen in 5 patients without 5-ALA-fluorescence were as followed: In two patients the histology was not conclusive (reactive gliosis without tumor cells) and in the other 3 patients the histology was low grade astrocytoma, glioblastoma, and Non-Hodgkin B cell lymphoma, respectively. The presence of 5-ALA-fluorescence correlated significantly with a hostological diagnostic yield (sensitivity 100%, specificity 40%, positive predictive value (PPV) 86% and negative predictive value (NPV) 100%, p=0.03 Fisher's exact test). The frozen section diagnosis matched the final diagnosis in 74% (17/23). The overall histopathologic diagnostic yield was 92% (21/23).
Conclusion: Intraoperative presence of 5-ALA-fluorescence in stereotactic biopsy specimen of unclear intracerebral pathologies has a high PPV and NPV for intraoperative confirmation of diagnostic tissue. The use of 5-ALA during stereotactic biopsy might increase diagnostic accuracy and possibly overcome the limitations of frozen section analysis.
