Photodynamic Diagnosis Using 5-Aminolevulinic Acid in 41 Biopsies for Primary Central Nervous System Lymphoma.
We evaluated the feasibility of 5-aminolevulinic acid (5-ALA)-mediated photodynamic diagnosis (PDD) in the biopsy for primary central nervous system lymphoma (PCNSL). 5-ALA (20 mg kg(-1) ) was administered orally 4 hours preoperatively. Forty-one biopsies obtained under PDD in 47 consecutive biopsies (46 patients) that were finally pathologically diagnosed as PCNSL were evaluated. Positive fluorescence was observed in 34 of those 41 biopsies (82.9%). An intraoperative pathological diagnosis (IOD) of suspected PCNSL was made in 21 of the biopsies with positive fluorescence (61.8%). However, the eight IODs in the remaining 13 biopsies (23.5%) were not correct (atypical cell, 4; high-grade glioma, 1; gliosis, 1; unremarkable, 2). In those 8 biopsies, PCNSL was confirmed by the final pathological diagnosis. There was no difference in the mean Mib-1 labeling index between the biopsies with positive fluorescence (86.5%) and those without positive fluorescence (90.0%). IOD was not performed in 6 biopsies; however, 5 of those biopsies (83.3%) showed positive fluorescence and were finally pathologically diagnosed as PCNSL. Use of PDD in biopsies for patients with suspected PCNSL is a reliable way of obtaining specimens of adequate quality for the final pathological diagnosis and may lead to improved diagnostic yield in the biopsy of PCNSL.
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Tetsuya
T
Yamamoto
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Eiichi
E
Ishikawa
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Shunichiro
S
Miki
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Noriaki
N
Sakamoto
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Alexander
A
Zaboronok
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Masahide
M
Matsuda
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Hiroyoshi
H
Akutsu
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Kei
K
Nakai
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Wataro
W
Tsuruta
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Akira
A
Matsumura
D000284:Administration, Oral; D000622:Aminolevulinic Acid / Q000008:administration & dosage* / Q000378:metabolism; D016543:Central Nervous System Neoplasms / Q000175:diagnosis*; D003952:Diagnostic Imaging; D005453:Fluorescence; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis*; D010778:Photochemotherapy; D012189:Retrospective Studies
D000622:Aminolevulinic Acid