title: Histological examination of false positive tissue resection using 5-aminolevulinic acid-induced fluorescence guidance.
abstract: Intraoperative 5-aminolevulinic acid (5-ALA)-induced fluorescence guidance for resection of malignant brain tumors was correlated with histological examination to investigate false positive findings in 42 patients with malignant glioma and six patients with metastatic brain tumor. Patients received a single 1 g oral dose of 5-ALA 2 hours before surgery. The tumor site was illuminated with a laser with a peak wavelength of 405 +/- 1 nm and output of 40 mW. Samples with strong fluorescence were obtained from the tumor bulk and samples with weak fluorescence from the tumor cavity. Fluorescence was observed in 36 of the 42 malignant gliomas and four of the six metastatic brain tumors. No tumor cells were found in fluorescent samples from six of the 36 malignant gliomas and all four metastatic brain tumors. Five of the six malignant gliomas were recurrent cases. Fluorescence was found in areas of peritumoral edema or inflammatory cell and reactive astrocyte infiltration. Intraoperative 5-ALA-induced fluorescence guidance is useful for the resection of initial malignant glioma since false positive results are rare, but only non-eloquent weak positive areas should be resected. In contrast, all weak positive areas of recurrent malignant gliomas must be resected. Weak positive areas of the peritumoral edema surrounding metastatic brain tumors should be removed carefully as false positive results are common.
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan. utsuki@med.kitasato-u.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Utsuki
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Oka
authors.forename: Sumito
authors.initials: S
authors.lastname: Sato
authors.forename: Satoru
authors.initials: S
authors.lastname: Shimizu
authors.forename: Sachio
authors.initials: S
authors.lastname: Suzuki
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanizaki
authors.forename: Koji
authors.initials: K
authors.lastname: Kondo
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Miyajima
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fujii
mesh_terms: D000622:Aminolevulinic Acid; D001932:Brain Neoplasms / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D005189:False Positive Reactions; D005453:Fluorescence; D005910:Glioma / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D017319:Photosensitizing Agents
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid