荧光素钠有助于引导非增强性脑胶质瘤的诊断性肿瘤组织取样。
Sodium Fluorescein Facilitates Guided Sampling of Diagnostic Tumor Tissue in Nonenhancing Gliomas.
机构信息
Department of Neurological Surgery, College of Physicians and Surgeons at Columbia University, New York, New York.
Department of Neurological Surgery, University of Colorado, Aurora, Colorado.
出版信息
Neurosurgery. 2018 May 1;82(5):719-727. doi: 10.1093/neuros/nyx271.
BACKGROUND
Accurate tissue sampling in nonenhancing (NE) gliomas is a unique surgical challenge due to their intratumoral histological heterogeneity and absence of contrast enhancement as a guide for intraoperative stereotactic guidance. Instead, T2/fluid-attenuated inversion-recovery (FLAIR) hyperintensity on MRI is commonly used as an imaging surrogate for pathological tissue, but sampling from this region can yield nondiagnostic or underdiagnostic brain tissue. Sodium fluorescein is an intraoperative fluorescent dye that has a high predictive value for tumor identification in areas of contrast enhancement and NE in glioblastomas. However, the underlying histopathological alterations in fluorescent regions of NE gliomas remain undefined.
OBJECTIVE
To evaluate whether fluorescein can identify diagnostic tissue and differentiate regions with higher malignant potential during surgery for NE gliomas, thus improving sampling accuracy.
METHODS
Thirteen patients who presented with NE, T2/FLAIR hyperintense lesions suspicious for glioma received fluorescein (10%, 3 mg/kg intravenously) during surgical resection.
RESULTS
Patchy fluorescence was identified within the T2/FLAIR hyperintense area in 10 of 13 (77%) patients. Samples taken from fluorescent regions were more likely to demonstrate diagnostic glioma tissue and cytologic atypia (P < .05). Fluorescein demonstrated a 95% positive predictive value for the presence of diagnostic tissue. Samples from areas of fluorescence also demonstrated greater total cell density and higher Ki-67 labeling than nonfluorescent biopsies (P < .05).
CONCLUSION
Fluorescence in NE gliomas is highly predictive of diagnostic tumor tissue and regions of higher cell density and proliferative activity.
背景
由于非增强（NE）胶质瘤的肿瘤内组织学异质性以及缺乏对比增强作为术中立体定向引导的指南，因此准确地对其进行组织取样是一项独特的手术挑战。相反，MRI 上的 T2/液体衰减反转恢复（FLAIR）高信号通常被用作病理组织的影像学替代物，但从该区域取样可能会导致非诊断性或诊断不足的脑组织。荧光素钠是一种术中荧光染料，它对增强和 NE 区域的脑胶质瘤的肿瘤识别具有很高的预测价值。然而，NE 胶质瘤荧光区域的潜在组织病理学改变仍未确定。
目的
评估荧光素是否可以识别诊断性组织，并在 NE 胶质瘤的手术中区分具有更高恶性潜能的区域，从而提高取样准确性。
方法
13 名患有 NE、T2/FLAIR 高信号病变的疑似脑胶质瘤患者在手术切除期间接受了荧光素（10%，静脉内 3mg/kg）。
结果
13 名患者中有 10 名（77%）在 T2/FLAIR 高信号区域内发现了斑片状荧光。取自荧光区域的样本更有可能显示出诊断性的胶质瘤组织和细胞学异型性（P<0.05）。荧光素对诊断性组织存在的阳性预测值为 95%。荧光区域的样本也显示出比非荧光活检更高的总细胞密度和更高的 Ki-67 标记（P<0.05）。
结论
NE 胶质瘤中的荧光高度预测了诊断性肿瘤组织以及细胞密度和增殖活性更高的区域。
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