title: Fluorescence and image guided resection in high grade glioma.
abstract: The extent of resection in high grade glioma is increasingly been shown to positively effect survival. Nevertheless, heterogeneity and migratory behavior of glioma cells make gross total resection very challenging. Several techniques were used in order to improve the detection of residual tumor. Aim of this study was to analyze advantages and limitations of fluorescence and image guided resection. A multicentric prospective study was designed to evaluate the accuracy of each method. Furthermore, the role of 5-aminolevulinc acid and neuronavigation were reviewed. Twenty-three patients harboring suspected high grade glioma, amenable to complete resection, were enrolled. Fluorescence and image guides were used to perform surgery. Multiple samples were obtained from the resection cavity of each lesion according to 5-ALA staining positivity and boundaries as delineated by neuronavigation. All samples were analyzed by a pathologist blinded to the intra-operative labeling. Decision-making based on fluorescence showed a sensitivity of 91.1% and a specificity of 89.4% (p<0.001). On the other hand, the image-guided resection accuracy was low (sensitivity: 57.8%; specificity: 57.4%; p=0.346). We observed that the sensitivity of 5-ALA can be improved by the combined use of neuronavigation, but this leads to a significant reduction in specificity. Thus, the use of auxiliary techniques should always be subject to critical skills of the surgeon. We advocate a large-scale study to further improve the assessment of multimodal approaches.
authors.affiliation: Division of Neurosurgery, Department of Neuroscience, University of Turin, Via Cherasco 15 - 10126 Torino, Italy. vincy.bip@alice.it
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Panciani
authors.forename: Marco
authors.initials: M
authors.lastname: Fontanella
authors.forename: Bawarjan
authors.initials: B
authors.lastname: Schatlo
authors.forename: Diego
authors.initials: D
authors.lastname: Garbossa
authors.forename: Alessandro
authors.initials: A
authors.lastname: Agnoletti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ducati
authors.forename: Michele
authors.initials: M
authors.lastname: Lanotte
mesh_terms: D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000378:metabolism; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D004396:Coloring Agents; D004268:DNA-Binding Proteins / Q000276:immunology; D005260:Female; D005453:Fluorescence; D005910:Glioma / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014157:Transcription Factors / Q000276:immunology
chemical_list: D004396:Coloring Agents; D004268:DNA-Binding Proteins; D014157:Transcription Factors; C077171:HIVEP2 protein, human; D000622:Aminolevulinic Acid