Proescholdt Martin A, Araceli Tommaso, Schebesch Karl-Michael, Doenitz Christian, Wendl Christina, Evert Katja, Noeva Ekaterina, Hoehne Julius, Riemenschneider Markus J, Hirsch Daniela, Schmidt Nils Ole, Sparrer Daniela, Lüke Florian, Heudobler Daniel, Pukrop Tobias, Blazquez Raquel
Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany; Wilhelm-Sander Neuro-Oncology Unit, University Hospital Regensburg, Regensburg, Germany.
Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany; Wilhelm-Sander Neuro-Oncology Unit, University Hospital Regensburg, Regensburg, Germany; Department of Neurosurgery, Klinikum Nürnberg, Nürnberg, Germany.
Transl Oncol. 2025 Jul 24;60:102480. doi: 10.1016/j.tranon.2025.102480.
While the histological growth pattern (HGP) of liver metastases is frequently evaluated, the same attention is often absent for brain metastases despite evidence suggesting its prognostic significance. This oversight may stem from the lack of a standardized method for assessing the HGP at the macro-metastasis / brain parenchyma interface (MMPI). MetInfilt is the first prospective, imaging-guided trial aimed at standardizing the collection and analysis of the HGP at the MMPI.
We recruited fifty patients. The MMPI was identified using preoperative contrast-enhanced T1-weighted MRI. Intraoperative confocal microscopy (CONVIVO) visualized the MMPI, while a YELLOW 560 nm filter in the surgical microscope facilitated precise tissue sampling. Samples from the MMPI and the core of the metastasis were collected for postoperative histological confirmation.
The protocol achieved successful tissue acquisition from the MMPI in 93.2 % of patients, meeting the study's primary endpoint. Preoperative MRI patterns strongly correlated with infiltrative HGPs, and CONVIVO accurately visualized the MMPI intraoperatively. Exploratory analyses suggest that infiltrative HGPs might negatively impact patient prognosis and represent a potential risk of meningeal metastasis.
Our neurosurgical protocol allows the successful and precise acquisition of tissue from the MMPI through presurgical imaging, intraoperative microscopy, and fluorescence-assisted sampling. The evaluation of the HGP in our limited patient cohort highlights its potential clinical significance and supports the urgent necessity to investigate it further for the benefit of patients with brain metastases.
Z-2019-1307-9.
虽然肝转移瘤的组织学生长模式（HGP）经常得到评估，但尽管有证据表明脑转移瘤的HGP具有预后意义，但人们对其关注却往往不足。这种忽视可能源于缺乏一种在宏观转移瘤/脑实质界面（MMPI）评估HGP的标准化方法。MetInfilt是第一项旨在标准化MMPI处HGP的收集和分析的前瞻性、影像引导试验。
我们招募了50名患者。使用术前对比增强T1加权MRI识别MMPI。术中共聚焦显微镜（CONVIVO）可显示MMPI，而手术显微镜中的560nm黄色滤光片有助于精确组织采样。收集MMPI和转移瘤核心的样本用于术后组织学确认。
该方案在93.2%的患者中成功从MMPI获取了组织，达到了研究的主要终点。术前MRI模式与浸润性HGP密切相关，CONVIVO在术中准确显示了MMPI。探索性分析表明，浸润性HGP可能对患者预后产生负面影响，并代表脑膜转移的潜在风险。
我们的神经外科手术方案通过术前成像、术中显微镜检查和荧光辅助采样，成功且精确地从MMPI获取了组织。在我们有限的患者队列中对HGP的评估突出了其潜在的临床意义，并支持迫切需要进一步研究以造福脑转移瘤患者。
Z-2019-1307-9。
