5-Aminolevulinic Acid Fluorescence Indicates Perilesional Brain Infiltration in Brain Metastases.
5-ALA
5-ALA, 5-Aminolevulinic acid
Brain metastasis
Brain tumor
Fluorescence-guided surgery
Histology
NSCLC, Non–small cell lung cancer
Tumor infiltration
Journal
World neurosurgery: X
ISSN: 2590-1397
Titre abrégé: World Neurosurg X
Pays: United States
ID NLM: 101747743
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
01
10
2019
accepted:
09
12
2019
entrez:
26
2
2020
pubmed:
26
2
2020
medline:
26
2
2020
Statut:
epublish
Résumé
In glioma surgery, 5-aminolevulinic acid (5-ALA) fluorescence reflects tumor infiltration, and fluorescence-assisted resection correlates with higher removal rates and improved progression-free survival. Recent studies report that a sizable proportion of brain metastases exhibit peritumoral infiltration on the cellular level. There is little information regarding whether 5-ALA is useful to guide surgery in the peritumoral zone in metastases. The aim of this study was to assess histologically whether 5-ALA fluorescence accurately reflects metastatic brain infiltration. Fluorescence-assisted tumor resection was performed in 27 patients with brain metastases. Patients received 20 mg/kg 5-ALA 3 hours before anesthesia. After resection, biopsy specimens of the surrounding parenchyma were analyzed for 5-ALA fluorescence and histologic evidence of infiltrating tumor cells. The correlation between 5-ALA positivity and immunohistochemical evidence of tumor in the peritumoral zone was also assessed. Of 27 metastases, 23 (85%) were 5-ALA positive. For qualitative tissue analysis, 110 of 125 samples were collected. Metastatic infiltration was present in 49 samples with faint or red fluorescence; 33 samples without fluorescence were tumor-free. The presence of metastatic infiltration correlated with fluorescence ( Infiltration of surrounding brain tissue is a common finding in brain metastases in selected primary tumors. 5-ALA fluorescence correlates with tumor cell infiltration and might guide more radical resection.
Sections du résumé
BACKGROUND
BACKGROUND
In glioma surgery, 5-aminolevulinic acid (5-ALA) fluorescence reflects tumor infiltration, and fluorescence-assisted resection correlates with higher removal rates and improved progression-free survival. Recent studies report that a sizable proportion of brain metastases exhibit peritumoral infiltration on the cellular level. There is little information regarding whether 5-ALA is useful to guide surgery in the peritumoral zone in metastases. The aim of this study was to assess histologically whether 5-ALA fluorescence accurately reflects metastatic brain infiltration.
METHODS AND MATERIALS
METHODS
Fluorescence-assisted tumor resection was performed in 27 patients with brain metastases. Patients received 20 mg/kg 5-ALA 3 hours before anesthesia. After resection, biopsy specimens of the surrounding parenchyma were analyzed for 5-ALA fluorescence and histologic evidence of infiltrating tumor cells. The correlation between 5-ALA positivity and immunohistochemical evidence of tumor in the peritumoral zone was also assessed.
RESULTS
RESULTS
Of 27 metastases, 23 (85%) were 5-ALA positive. For qualitative tissue analysis, 110 of 125 samples were collected. Metastatic infiltration was present in 49 samples with faint or red fluorescence; 33 samples without fluorescence were tumor-free. The presence of metastatic infiltration correlated with fluorescence (
CONCLUSIONS
CONCLUSIONS
Infiltration of surrounding brain tissue is a common finding in brain metastases in selected primary tumors. 5-ALA fluorescence correlates with tumor cell infiltration and might guide more radical resection.
Identifiants
pubmed: 32095783
doi: 10.1016/j.wnsx.2019.100069
pii: S2590-1397(19)30110-3
pii: 100069
pmc: PMC7026613
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100069Informations de copyright
© 2019 The Author(s).
Déclaration de conflit d'intérêts
This study was funded by the German Federal Ministry of Education and Science project MetastaSys in the platform Medical Systems (0316173).
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