Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
J Neurooncol. 2024 Oct;170(1):11-29. doi: 10.1007/s11060-024-04779-z. Epub 2024 Aug 10.
Stereotactic brain biopsies are highly efficient for diagnosing intracerebral pathologies, particularly when surgical resection is infeasible. Fluorescence-based agents such as 5-aminolevulinic acid (5-ALA) and fluorescein sodium (NaFl) can enhance diagnostic accuracy and safety, improving the visualization of lesional tissues. This meta-analysis aimed to evaluate their effect on diagnostic yield and complication rates of brain biopsies.
This study adhered to Cochrane and PRISMA guidelines. We assessed studies for diagnostic yield and complication rates. Data was analyzed using a random-effects model in RStudio. Diagnostic accuracy measures such as sensitivity and predictive values were calculated based on fluorescence visibility in biopsy samples.
Thirty-two non-randomized studies were included, comprising 947 patients, with a mean age ranging from 37 to 77 years, and a mean sample number ranging from 1 to 15 specimens. Diagnostic yields were high: 93% for NaFl and 96% for 5-ALA. Major complications occurred in 3% of procedures with both agents, while minor complications were reported in 7% and 5% with NaFl and 5-ALA respectively. The Negative-predictive-value (NPV) of 5-ALA and NaFl were 8-11% and 60-80% respectively. NaFl demonstrates higher sensitivity and specificity at 84% and 100% compared to 5-ALA's 66%. and 85% respectively.
5-ALA and NaFl provide high diagnostic yields with acceptable safety profiles in stereotactic biopsies. NaFl showed higher sensitivity and specificity. NaFl outperforms 5ALA in terms of NPV making it more efficient for small lesions near eloquent regions or major blood vessels. The significance of these findings can be further ascertained through randomized trials.
立体定向脑活检对于诊断颅内病变非常有效，尤其是在手术切除不可行的情况下。基于荧光的试剂，如 5-氨基酮戊酸（5-ALA）和荧光素钠（NaFl），可以提高诊断准确性和安全性，改善病变组织的可视化效果。本荟萃分析旨在评估它们对脑活检诊断产量和并发症发生率的影响。
本研究遵循 Cochrane 和 PRISMA 指南。我们评估了研究的诊断产量和并发症发生率。使用 RStudio 中的随机效应模型对数据进行分析。根据活检样本中的荧光可见性，计算了诊断准确性指标，如敏感性和预测值。
纳入了 32 项非随机研究，包括 947 名患者，平均年龄为 37 至 77 岁，平均样本数量为 1 至 15 个标本。诊断产量很高：NaFl 为 93%，5-ALA 为 96%。两种试剂的主要并发症发生率为 3%，而 NaFl 和 5-ALA 的轻微并发症发生率分别为 7%和 5%。5-ALA 和 NaFl 的阴性预测值（NPV）分别为 8-11%和 60-80%。与 5-ALA 的 66%和 85%相比，NaFl 的敏感性和特异性分别为 84%和 100%。
5-ALA 和 NaFl 在立体定向活检中提供了高的诊断产量和可接受的安全性。NaFl 显示出更高的敏感性和特异性。在 NPV 方面，NaFl 优于 5-ALA，使其在靠近语言区或大血管的小病变中更有效。通过随机试验可以进一步确定这些发现的意义。
