Department of Neurosurgery, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
Department of HPB and Solid Organ Transplant, Amrita Hospital, Faridabad, India.
World Neurosurg. 2024 Apr;184:e737-e742. doi: 10.1016/j.wneu.2024.02.021. Epub 2024 Feb 9.
The factors on which the accuracy of stereotactic brain biopsy depends are the competence of the neurosurgeon in obtaining a representative sample and the ability of the neuropathologist to make a histological diagnosis from a minuscule sample. Over the years intraoperative frozen section has enhanced the diagnostic yield of this minimally invasive procedure. Use of fluorescence in achieving a greater extent of resection is well-established in contemporary neurosurgical practice. This ability of brain tumors to take up the fluorescein sodium dye and glow under the YELLOW 560-nm filter has been utilized in a handful of studies to increase the diagnostic accuracy of stereotactic biopsy.
We performed a prospective study where the fluorescein sodium dye was injected at a low dose and fluorescence of the biopsied core was compared with that of a tissue obtained from the normal parenchyma. Sample was labeled 'truly fluorescent' only when the glow was more than that of the tissue from normal parenchyma.
On cross-tabulating the index test (true fluorescence status) and the reference standard test (final histopathological report) the sensitivity of acquiring a representative sample was found to be 94.74%, specificity was 100%. The positive predictive value and negative predictive value were calculated to be 100% and 50% respectively. The diagnostic yield was comparable to that of the intraoperative frozen section.
The use of the YELLOW 560-nm filter can make stereotactic biopsy faster, safer, less cumbersome, and more cost-effective, and can be used as a substitute for the frozen section in resource-constrained centers.
立体定向脑活检的准确性取决于神经外科医生获取代表性样本的能力和神经病理学家从微小样本中做出组织学诊断的能力。多年来，术中冷冻切片提高了这种微创程序的诊断效果。荧光在实现更大程度的切除方面的应用在当代神经外科实践中已经得到了很好的证实。脑肿瘤摄取荧光素钠染料并在黄色 560nm 滤光片下发光的这种能力已被少数研究用于提高立体定向活检的诊断准确性。
我们进行了一项前瞻性研究，其中以低剂量注射荧光素钠染料，并比较活检核心的荧光与正常实质组织中获得的组织的荧光。只有当发光强度大于正常实质组织中的组织时，才将样本标记为“真正荧光”。
在交叉制表索引测试（真实荧光状态）和参考标准测试（最终组织病理学报告）时，获得代表性样本的敏感性为 94.74%，特异性为 100%。阳性预测值和阴性预测值分别计算为 100%和 50%。诊断效果与术中冷冻切片相当。
黄色 560nm 滤光片的使用可以使立体定向活检更快、更安全、更不繁琐、更具成本效益，并且可以替代资源有限的中心的冷冻切片。
