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Diagnostic yield of fluorescence-assisted frame-based stereotactic biopsies of intracerebral lesions in comparison with frozen-section analysis

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Stereotactic biopsies are routinely used to establish a histological diagnosis of unclear cerebral pathologies. Intraoperatively, frozen-section analysis often confirms diagnostic tissue but also exhibits methodological pitfalls. Intraoperative five-aminolevulinic acid (5-ALA)-fluorescence has been described not only in gliomas but also in other cerebral pathologies. In this study, we assessed the 5-ALA contribution to the intraoperative confirmation of diagnostic tissue in frame-based stereotactic biopsies of unclear intracerebral lesions in direct comparison with frozen-section analysis.

Methods

Patients scheduled for stereotactic biopsies of unclear intracerebral pathologies received 5-ALA preoperatively. Obtained samples were intraoperatively analyzed for the presence of 5-ALA-fluorescence. One sample was used for frozen-section and a second one for permanent histopathological analysis. The diagnostic yield of frozen-section and intraoperative 5-ALA-fluorescence was calculated. The inclusion criteria for this retrospective analysis were unclear intracerebral lesions with inconclusive imaging findings and several differential diagnoses.

Results

A total of 39 patients with 122 obtained specimens were included. The overall diagnostic yield was 92.3%. 5-ALA-positive samples were obtained in 74.3% (29/39) of patients and all these samples contained diagnostic tissue. 5-ALA-fluorescence confirmed diagnostic tissue with a sensitivity of 100%, a specificity of 27%, a positive predictive value (PPV) of 78%, and a negative predictive value (NPV) of 100%. A clear diagnosis could be predicted by frozen section with a sensitivity of 80%, a specificity of 100%, a PPV of 100%, and NPV of 30%; Fisher’s exact test p = 0.01.

Conclusion

The 5-ALA-fluorescence in stereotactic biopsies of unclear intracerebral pathologies exhibits a high PPV/NPV for intraoperative confirmation of diagnostic tissue and might increase the diagnostic yield of the procedure by overcoming some of the limitations of frozen-section.

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All available data is presented in the manuscript.

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Funding

The study was not funded.

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Authors and Affiliations

  1. Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany

    Vesna Malinova, Kajetan von Eckardstein, Dorothee Mielke & Veit Rohde

  2. Department of Neurosurgery, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany

    Kajetan von Eckardstein

Authors
  1. Vesna Malinova
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  2. Kajetan von Eckardstein
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  3. Dorothee Mielke
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  4. Veit Rohde
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Correspondence to Vesna Malinova.

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The authors declare that they have no conflict of interest.

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Due to retrospective nature of the study informed consent was waived.

Ethical approval

The study was approved by the local ethics committee of the University Medicine Göttingen (Study Identification Number 16/9/18). Due to retrospective nature of the study informed consent was deemed not necessary and all the procedures being performed were part of the routine care. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration.

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Malinova, V., von Eckardstein, K., Mielke, D. et al. Diagnostic yield of fluorescence-assisted frame-based stereotactic biopsies of intracerebral lesions in comparison with frozen-section analysis. J Neurooncol 149, 315–323 (2020). https://doi.org/10.1007/s11060-020-03608-3

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  • DOI: https://doi.org/10.1007/s11060-020-03608-3

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