Schatlo Bawarjan, Stockhammer Florian, Barrantes-Freer Alonso, Bleckmann Annalen, Siam Laila, Pukrop Tobias, Rohde Veit
Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University of Göttingen, Göttingen, Germany.
Department of Neurosurgery, Municipal Hospital Dresden, Dresden, Germany.
World Neurosurg X. 2019 Dec 16;5:100069. doi: 10.1016/j.wnsx.2019.100069. eCollection 2020 Jan.
In glioma surgery, 5-aminolevulinic acid (5-ALA) fluorescence reflects tumor infiltration, and fluorescence-assisted resection correlates with higher removal rates and improved progression-free survival. Recent studies report that a sizable proportion of brain metastases exhibit peritumoral infiltration on the cellular level. There is little information regarding whether 5-ALA is useful to guide surgery in the peritumoral zone in metastases. The aim of this study was to assess histologically whether 5-ALA fluorescence accurately reflects metastatic brain infiltration.
Fluorescence-assisted tumor resection was performed in 27 patients with brain metastases. Patients received 20 mg/kg 5-ALA 3 hours before anesthesia. After resection, biopsy specimens of the surrounding parenchyma were analyzed for 5-ALA fluorescence and histologic evidence of infiltrating tumor cells. The correlation between 5-ALA positivity and immunohistochemical evidence of tumor in the peritumoral zone was also assessed.
Of 27 metastases, 23 (85%) were 5-ALA positive. For qualitative tissue analysis, 110 of 125 samples were collected. Metastatic infiltration was present in 49 samples with faint or red fluorescence; 33 samples without fluorescence were tumor-free. The presence of metastatic infiltration correlated with fluorescence ( < 0.001). Tumor infiltration correlated with fluorescence (blue fluorescence 0.09% ± 0.04% and red or faint fluorescence 3.26%; = 0.003).
Infiltration of surrounding brain tissue is a common finding in brain metastases in selected primary tumors. 5-ALA fluorescence correlates with tumor cell infiltration and might guide more radical resection.
在胶质瘤手术中，5-氨基乙酰丙酸（5-ALA）荧光可反映肿瘤浸润情况，荧光辅助切除术与更高的切除率及改善的无进展生存期相关。近期研究报告称，相当一部分脑转移瘤在细胞水平上存在瘤周浸润。关于5-ALA是否有助于指导转移瘤瘤周区域的手术，目前信息较少。本研究的目的是通过组织学评估5-ALA荧光是否能准确反映转移性脑浸润情况。
对27例脑转移瘤患者进行了荧光辅助肿瘤切除术。患者在麻醉前3小时接受20mg/kg的5-ALA。切除术后，对周围实质的活检标本进行5-ALA荧光分析及肿瘤浸润细胞的组织学证据分析。还评估了5-ALA阳性与瘤周区域肿瘤免疫组化证据之间的相关性。
27个转移瘤中，23个（85%）为5-ALA阳性。对于定性组织分析，共收集了125个样本中的110个。49个有微弱或红色荧光的样本存在转移浸润；33个无荧光的样本无肿瘤。转移浸润的存在与荧光相关（<0.001）。肿瘤浸润与荧光相关（蓝色荧光0.09%±0.04%，红色或微弱荧光3.26%；=0.003）。
在某些原发性肿瘤的脑转移瘤中，周围脑组织浸润是常见表现。5-ALA荧光与肿瘤细胞浸润相关，可能有助于指导更彻底的切除。
