title: Strong 5-aminolevulinic acid-induced fluorescence is a novel intraoperative marker for representative tissue samples in stereotactic brain tumor biopsies.
abstract: Stereotactic biopsies represent a routine neurosurgical procedure for the diagnosis of intracranial lymphomas and selected diffusely infiltrating gliomas. Acquisition of tissue samples that do not allow correct tumor typing and grading is, however, not uncommon. Five-aminolevulinic acid (5-ALA) has been shown to accumulate in malignant tumor tissue. The aim of this study was to prospectively investigate the clinical usability of 5-ALA for intraoperative detection of representative tissue in stereotactic tumor biopsies. Fifty consecutive patients underwent frameless stereotactic biopsy for a suspected brain tumor. 5-ALA was administered 4 h before anesthesia. Serial biopsy samples were obtained and intraoperatively checked for 5-ALA fluorescence (strong, vague, or none) using a modified neurosurgical microscope. All samples were examined for the presence of representative tumor tissue according to neuroimaging (MRI, positron emission tomography, and/or chemical shift imaging) and histopathological parameters. Visible 5-ALA fluorescence was observed in 43/50 patients (strong in 39 and vague fluorescence in four cases). At biopsy target, 52/53 samples of glioblastomas, 9/10 samples of gliomas grade III, and 14/16 samples of lymphomas revealed strong 5-ALA fluorescence. Samples with strong 5-ALA fluorescence were only observed at, but not outside the biopsy target. All tissue samples with strong 5-ALA fluorescence were representative according to our neuroimaging and histopathological criteria (positive predictive value of 100%). Our data indicate that strong 5-ALA fluorescence is a reliable and immediately available intraoperative marker of representative tumor tissue of malignant gliomas and intracranial lymphomas in stereotactic biopsies. Thereby, the application of 5-ALA in stereotactic brain tumor biopsies may in future reduce costs for operating room and neuropathology and may decrease procedure-related morbidity.
authors.affiliation: Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Widhalm
authors.forename: Georgi
authors.initials: G
authors.lastname: Minchev
authors.forename: Adelheid
authors.initials: A
authors.lastname: Woehrer
authors.forename: Matthias
authors.initials: M
authors.lastname: Preusser
authors.forename: Barbara
authors.initials: B
authors.lastname: Kiesel
authors.forename: Julia
authors.initials: J
authors.lastname: Furtner
authors.forename: Aygül
authors.initials: A
authors.lastname: Mert
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Ieva
authors.forename: Boguslaw
authors.initials: B
authors.lastname: Tomanek
authors.forename: Daniela
authors.initials: D
authors.lastname: Prayer
authors.forename: Christine
authors.initials: C
authors.lastname: Marosi
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Hainfellner
authors.forename: Engelbert
authors.initials: E
authors.lastname: Knosp
authors.forename: Stefan
authors.initials: S
authors.lastname: Wolfsberger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid; D001706:Biopsy; D001932:Brain Neoplasms / Q000473:pathology*; D005260:Female; D005453:Fluorescence; D005910:Glioma / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D019635:Neurosurgical Procedures; D017319:Photosensitizing Agents; D055815:Young Adult
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid