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High Diagnostic Accuracy of Visible 5-ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue.
Lasers Surg Med. 2020 Jul 01 [Online ahead of print]LS

Abstract

BACKGROUND AND OBJECTIVES

Complete neurosurgical resection of intracranial meningiomas is essential to avoid residual tumor tissue and thus minimize the risk of tumor recurrence. However, local recurrence of meningiomas is not uncommon mainly due to insufficient intraoperative detection of residual tumor tissue within the tumor bulk or peritumoral tissue such as bone and satellite lesions. Although 5-aminolevulinic acid (5-ALA) induced fluorescence was found to visualize the majority of meningiomas, no comprehensive histopathological assessment of fluorescing samples from the tumor bulk and peritumoral tissue is available. The aim of our study was thus to histopathologically analyze a large series of tissue samples derived from meningioma surgery to assess the positive predictive value (PPV) of visible 5-ALA fluorescence.

STUDY DESIGN/MATERIALS AND METHODS

In this study, we retrospectively investigated a series of tissue samples with visible 5-ALA fluorescence collected during surgery of intracranial meningiomas from the tumor bulk and peritumoral tissue including the bone flap, dura/dural tail, arachnoidea, adjacent cortex, and satellite lesions. The tumor diagnosis was established according to the World Health Organization (WHO) criteria and all collected fluorescing samples were screened for presence of tumor tissue to calculate the PPV.

RESULTS

Altogether, 191 tissue samples with visible 5-ALA fluorescence derived during surgery of 85 meningiomas (63 WHO grade I, 17 WHO grade II, and 5 WHO grade III) were included. In detail, 158 samples from the tumor bulk and 33 specimens from the peritumoral tissue were investigated. According to histopathological analysis, the PPV of 5-ALA fluorescence was significantly higher in samples from the tumor bulk (100%) as compared with peritumoral tissue (73%; P < 0.001). With regard to peritumoral tissue, tumor tissue was present in most fluorescing samples from the satellite lesions (100%), the bone flap (92%), arachnoidea (83%), and dura/dural tail (75%). In contrast, tumor tissue was absent in the majority of samples from fluorescing cortex (six of seven samples; 86%). However, distinct reactive tissue alterations were found in all six tumor-free fluorescing cortex samples and additional vascular proliferation in two cases.

CONCLUSION

In this largest series to date, visible 5-ALA fluorescence is characterized by a high PPV detecting tumor bulk and peritumoral tissue in intracranial meningiomas. Thus, 5-ALA fluorescence supports the neurosurgeon in identifying residual tumor tissue at relevant surgical sites to optimize meningioma surgery and minimize the risk of local recurrence. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.

Authors+Show Affiliations

Department of Neurosurgery, Medical University Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria. Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University Vienna, Spitalgasse 23, BT86/E 01, Vienna, 1090, Austria.Department of Neurosurgery, Medical University Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria. Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University Vienna, Spitalgasse 23, BT86/E 01, Vienna, 1090, Austria.Department of Neurosurgery, Medical University Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria.Department of Neurosurgery, Medical University Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria. Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University Vienna, Spitalgasse 23, BT86/E 01, Vienna, 1090, Austria.Department of Neurosurgery, Medical University Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria. Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University Vienna, Spitalgasse 23, BT86/E 01, Vienna, 1090, Austria.Department of Neurosurgery, Medical University Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria. Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University Vienna, Spitalgasse 23, BT86/E 01, Vienna, 1090, Austria.Department of Neurosurgery, Medical University Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria. Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University Vienna, Spitalgasse 23, BT86/E 01, Vienna, 1090, Austria.Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University Vienna, Spitalgasse 23, BT86/E 01, Vienna, 1090, Austria. Department of Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria.Department of Neurosurgery, Medical University Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria. Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University Vienna, Spitalgasse 23, BT86/E 01, Vienna, 1090, Austria.Department of Neurosurgery, Medical University Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria. Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University Vienna, Spitalgasse 23, BT86/E 01, Vienna, 1090, Austria.Department of Neurosurgery, Medical University Vienna, Waehringer Gürtel 18-20, Vienna, 1090, Austria. Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University Vienna, Spitalgasse 23, BT86/E 01, Vienna, 1090, Austria.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32608510

Citation

Wadiura, Lisa I., et al. "High Diagnostic Accuracy of Visible 5-ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue." Lasers in Surgery and Medicine, 2020.
Wadiura LI, Millesi M, Makolli J, et al. High Diagnostic Accuracy of Visible 5-ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue. Lasers Surg Med. 2020.
Wadiura, L. I., Millesi, M., Makolli, J., Wais, J., Kiesel, B., Mischkulnig, M., Mercea, P. A., Roetzer, T., Knosp, E., Rössler, K., & Widhalm, G. (2020). High Diagnostic Accuracy of Visible 5-ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue. Lasers in Surgery and Medicine. https://doi.org/10.1002/lsm.23294
Wadiura LI, et al. High Diagnostic Accuracy of Visible 5-ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue. Lasers Surg Med. 2020 Jul 1; PubMed PMID: 32608510.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High Diagnostic Accuracy of Visible 5-ALA Fluorescence in Meningioma Surgery According to Histopathological Analysis of Tumor Bulk and Peritumoral Tissue. AU - Wadiura,Lisa I, AU - Millesi,Matthias, AU - Makolli,Jessica, AU - Wais,Jonathan, AU - Kiesel,Barbara, AU - Mischkulnig,Mario, AU - Mercea,Petra A, AU - Roetzer,Thomas, AU - Knosp,Engelbert, AU - Rössler,Karl, AU - Widhalm,Georg, Y1 - 2020/07/01/ PY - 2020/05/15/received PY - 2020/06/16/revised PY - 2020/06/18/accepted PY - 2020/7/2/pubmed PY - 2020/7/2/medline PY - 2020/7/2/entrez KW - 5-ALA KW - fluorescence KW - histopathology KW - meningioma KW - peritumoral tissue KW - tumor bulk JF - Lasers in surgery and medicine JO - Lasers Surg Med N2 - BACKGROUND AND OBJECTIVES: Complete neurosurgical resection of intracranial meningiomas is essential to avoid residual tumor tissue and thus minimize the risk of tumor recurrence. However, local recurrence of meningiomas is not uncommon mainly due to insufficient intraoperative detection of residual tumor tissue within the tumor bulk or peritumoral tissue such as bone and satellite lesions. Although 5-aminolevulinic acid (5-ALA) induced fluorescence was found to visualize the majority of meningiomas, no comprehensive histopathological assessment of fluorescing samples from the tumor bulk and peritumoral tissue is available. The aim of our study was thus to histopathologically analyze a large series of tissue samples derived from meningioma surgery to assess the positive predictive value (PPV) of visible 5-ALA fluorescence. STUDY DESIGN/MATERIALS AND METHODS: In this study, we retrospectively investigated a series of tissue samples with visible 5-ALA fluorescence collected during surgery of intracranial meningiomas from the tumor bulk and peritumoral tissue including the bone flap, dura/dural tail, arachnoidea, adjacent cortex, and satellite lesions. The tumor diagnosis was established according to the World Health Organization (WHO) criteria and all collected fluorescing samples were screened for presence of tumor tissue to calculate the PPV. RESULTS: Altogether, 191 tissue samples with visible 5-ALA fluorescence derived during surgery of 85 meningiomas (63 WHO grade I, 17 WHO grade II, and 5 WHO grade III) were included. In detail, 158 samples from the tumor bulk and 33 specimens from the peritumoral tissue were investigated. According to histopathological analysis, the PPV of 5-ALA fluorescence was significantly higher in samples from the tumor bulk (100%) as compared with peritumoral tissue (73%; P < 0.001). With regard to peritumoral tissue, tumor tissue was present in most fluorescing samples from the satellite lesions (100%), the bone flap (92%), arachnoidea (83%), and dura/dural tail (75%). In contrast, tumor tissue was absent in the majority of samples from fluorescing cortex (six of seven samples; 86%). However, distinct reactive tissue alterations were found in all six tumor-free fluorescing cortex samples and additional vascular proliferation in two cases. CONCLUSION: In this largest series to date, visible 5-ALA fluorescence is characterized by a high PPV detecting tumor bulk and peritumoral tissue in intracranial meningiomas. Thus, 5-ALA fluorescence supports the neurosurgeon in identifying residual tumor tissue at relevant surgical sites to optimize meningioma surgery and minimize the risk of local recurrence. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC. SN - 1096-9101 UR - https://www.unboundmedicine.com/medline/citation/32608510/High_Diagnostic_Accuracy_of_Visible_5-ALA_Fluorescence_in_Meningioma_Surgery_According_to_Histopathological_Analysis_of_Tumor_Bulk_and_Peritumoral_Tissue L2 - https://doi.org/10.1002/lsm.23294 DB - PRIME DP - Unbound Medicine ER -
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