Catapano Giuseppe, Sgulò Francesco Giovanni, Seneca Vincenzo, Iorio Giuseppina, de Notaris Matteo, di Nuzzo Giuseppe
Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy.
Neurosurg Rev. 2019 Jun;42(2):309-318. doi: 10.1007/s10143-018-0947-z. Epub 2018 Jan 30.
Over the last years, fluorescence-based technology has begun an emergent intraoperative method for diagnostic confirmation of brain tumor tissue in stereotactic needle biopsy. However, the actual level of evidence is quite low, especially about fluorescein sodium (FL) application. This method needs to be further validated and better analyzed about its impact in clinical practice. Retrospective analysis of 11 cases with contrast-enhancing brain tumors, underwent awake stereotactic needle biopsy with intraoperative FL assistance (group 1), was verified under the operative microscope filter. This group was matched with a control group of 18 patients (group 2). In addition, a systematic literature review was performed in PubMed/Medline database according to PRISMA statement. All studies concerning FL or 5-ALA application in stereotactic biopsy as intraoperative confirmation of brain tumor tissue were included. The primary endpoint was the evaluation of diagnostic accuracy. In group 1, all fluorescent specimens were diagnostic. The number of samplings was the useful minimum and non-use of intraoperative neuropathological examination allowed to significantly reduce procedure time (42.09 vs 69.72 min of group 2). No complications occurred, and the average hospitalization time after procedure was 1.09 days (vs 2.33 of group 2). Literature analysis supports the usefulness of photodiagnosis and its high diagnostic yield especially at the core of high-grade/contrast-enhancing tumors. FL assistance during stereotactic biopsy of contrast-enhancing brain tumors may give a real-time confirmation of tumor tissue, maximizing the diagnostic yield, and reducing time of procedure, morbidity, and hospitalization.
在过去几年中，基于荧光的技术已成为立体定向针吸活检术中用于确诊脑肿瘤组织的一种新兴方法。然而，实际的证据水平相当低，尤其是关于荧光素钠（FL）的应用。该方法需要进一步验证，并更好地分析其在临床实践中的影响。对11例有强化的脑肿瘤患者进行回顾性分析，这些患者在术中FL辅助下接受清醒立体定向针吸活检（第1组），并在手术显微镜滤光片下进行验证。该组与18例患者的对照组（第2组）进行匹配。此外，根据PRISMA声明在PubMed/Medline数据库中进行了系统的文献综述。纳入了所有关于FL或5-氨基乙酰丙酸（5-ALA）在立体定向活检中作为脑肿瘤组织术中确诊应用的研究。主要终点是评估诊断准确性。在第1组中，所有荧光标本均具有诊断价值。采样数量为有用的最小值，并且不使用术中神经病理学检查可显著缩短手术时间（第2组为69.72分钟，第1组为42.09分钟）。未发生并发症，术后平均住院时间为1.09天（第2组为2.33天）。文献分析支持光诊断的有用性及其高诊断率，尤其是在高级别/强化肿瘤的核心部位。在强化脑肿瘤的立体定向活检中，FL辅助可实时确认肿瘤组织，最大限度地提高诊断率，并减少手术时间、发病率和住院时间。
