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Fluorescein sodium-guided biopsy or resection in primary central nervous system lymphomas with contrast-enhancing lesion in MRI

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Abstract

Background

Surgical procedures are critical in making a conclusive histopathological diagnosis of primary central nervous system lymphoma (PCNSL), which typically presents contrast-enhancing lesions in magnetic resonance imaging (MRI). The fluorescein sodium-guided technique could enhance tumor visibility. We reported a series of patients with PCNSL underwent fluorescein sodium-guided surgical procedures.

Patients and methods

12 patients clinically considered brain tumors underwent fluorescein sodium-guided surgery in Sun Yat-sen University Cancer Center from March 2016 to July 2017. The age of 4 female and 8 male patients ranges from 39 to 62 years. In 4 patients, corticosteroid had been prescribed before surgery due to intracranial hypertension. After injection of low dose of sodium fluorescein (3–5 mg/kg), the lesions with strong fluorescence staining were identified as the target area for biopsy or resection.

Results

Based on the targeted tissues with bright and homogenous fluorescence staining, all 12 patients were conclusively diagnosed as B cell non-Hodgkin’s lymphoma (diffuse large cell). The specificity of the specimens sent for frozen section was 86.4% (19/22). No fluorescein sodium associated side effects were observed.

Conclusion

Fluorescein sodium guided surgery is an effective and safe tool in biopsy or tumor resection in patients suspicious for PCNSL with preoperative MRI presented contrast-enhanced homogenous lesions. Such technique might still be considered in those patients who have been pretreated with corticosteroid.

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Funding

This work was funded by Science and Technology Planning Project of Guangdong Province, China [Grant Number 2013B090500095], [grant number 2014A020212576], [Grant Number 2015B010125003], also by Science and Technology Program of Guangzhou, China [Grant Number 201704020133]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Fu-hua Lin, Xiang-heng Zhang, Ji Zhang, Zhen-qiang He, and Hao Duan have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, State Key Laboratory of Oncology in South China, Collaborative Innovation, Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, China

    Fu-hua Lin, Xiang-heng Zhang, Ji Zhang, Zhen-qiang He, Hao Duan, Chao Ke, Ke Sai, Xiao-bing Jiang, Fuad AL-Nahari & Yong-gao Mou

  2. Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, China

    Shao-yan Xi

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  1. Fu-hua Lin
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Contributions

All authors contributed equally to the paper. XHZ, FHL, ZQH, HD and JZ drafted the manuscript. CK, KS, XBJ and FALN performed data collection. YGM supervised the data collection and revised this article. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yong-gao Mou.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

Study approved was obtained from the Medical Ethics Committees of SYSUCC and the study was conducted in accordance with the ethical standard of the World Medical Association Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study. All patients were provided written informed consent for their information to be stored and used in the hospital database.

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Lin, Fh., Zhang, Xh., Zhang, J. et al. Fluorescein sodium-guided biopsy or resection in primary central nervous system lymphomas with contrast-enhancing lesion in MRI. J Neurooncol 139, 757–765 (2018). https://doi.org/10.1007/s11060-018-2924-3

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