BACKGROUND: Accurate tissue sampling in nonenhancing (NE) gliomas is a unique surgical challenge due to their intratumoral histological heterogeneity and absence of contrast enhancement as a guide for intraoperative stereotactic guidance. Instead, T2/fluid-attenuated inversion-recovery (FLAIR) hyperintensity on MRI is commonly used as an imaging surrogate for pathological tissue, but sampling from this region can yield nondiagnostic or underdiagnostic brain tissue. Sodium fluorescein is an intraoperative fluorescent dye that has a high predictive value for tumor identification in areas of contrast enhancement and NE in glioblastomas. However, the underlying histopathological alterations in fluorescent regions of NE gliomas remain undefined. OBJECTIVE: To evaluate whether fluorescein can identify diagnostic tissue and differentiate regions with higher malignant potential during surgery for NE gliomas, thus improving sampling accuracy. METHODS: Thirteen patients who presented with NE, T2/FLAIR hyperintense lesions suspicious for glioma received fluorescein (10%, 3 mg/kg intravenously) during surgical resection. RESULTS: Patchy fluorescence was identified within the T2/FLAIR hyperintense area in 10 of 13 (77%) patients. Samples taken from fluorescent regions were more likely to demonstrate diagnostic glioma tissue and cytologic atypia (P < .05). Fluorescein demonstrated a 95% positive predictive value for the presence of diagnostic tissue. Samples from areas of fluorescence also demonstrated greater total cell density and higher Ki-67 labeling than nonfluorescent biopsies (P < .05). CONCLUSION: Fluorescence in NE gliomas is highly predictive of diagnostic tumor tissue and regions of higher cell density and proliferative activity.
BACKGROUND: Accurate tissue sampling in nonenhancing (NE) gliomas is a unique surgical challenge due to their intratumoral histological heterogeneity and absence of contrast enhancement as a guide for intraoperative stereotactic guidance. Instead, T2/fluid-attenuated inversion-recovery (FLAIR) hyperintensity on MRI is commonly used as an imaging surrogate for pathological tissue, but sampling from this region can yield nondiagnostic or underdiagnostic brain tissue. Sodium fluorescein is an intraoperative fluorescent dye that has a high predictive value for tumor identification in areas of contrast enhancement and NE in glioblastomas. However, the underlying histopathological alterations in fluorescent regions of NE gliomas remain undefined. OBJECTIVE: To evaluate whether fluorescein can identify diagnostic tissue and differentiate regions with higher malignant potential during surgery for NE gliomas, thus improving sampling accuracy. METHODS: Thirteen patients who presented with NE, T2/FLAIR hyperintense lesions suspicious for glioma received fluorescein (10%, 3 mg/kg intravenously) during surgical resection. RESULTS: Patchy fluorescence was identified within the T2/FLAIR hyperintense area in 10 of 13 (77%) patients. Samples taken from fluorescent regions were more likely to demonstrate diagnostic glioma tissue and cytologic atypia (P < .05). Fluorescein demonstrated a 95% positive predictive value for the presence of diagnostic tissue. Samples from areas of fluorescence also demonstrated greater total cell density and higher Ki-67 labeling than nonfluorescent biopsies (P < .05). CONCLUSION: Fluorescence in NE gliomas is highly predictive of diagnostic tumor tissue and regions of higher cell density and proliferative activity.
Authors: Ran Xu; Judith Rösler; Wanda Teich; Josefine Radke; Anton Früh; Lea Scherschinski; Julia Onken; Peter Vajkoczy; Martin Misch; Katharina Faust Journal: J Clin Med Date: 2022-06-10 Impact factor: 4.964
Authors: Rimas V Lukas; Derek A Wainwright; Erik Ladomersky; Sean Sachdev; Adam M Sonabend; Roger Stupp Journal: Oncology (Williston Park) Date: 2019-03-13 Impact factor: 2.990
Authors: Evgenii Belykh; Arpan A Patel; Eric J Miller; Baran Bozkurt; Kaan Yağmurlu; Eric C Woolf; Adrienne C Scheck; Jennifer M Eschbacher; Peter Nakaji; Mark C Preul Journal: Cancer Manag Res Date: 2018-08-30 Impact factor: 3.989
Authors: Alexander J Schupper; Manasa Rao; Nicki Mohammadi; Rebecca Baron; John Y K Lee; Francesco Acerbi; Constantinos G Hadjipanayis Journal: Front Neurol Date: 2021-06-16 Impact factor: 4.003
Authors: Petros D Petridis; Craig I Horenstein; Brianna Pereira; Peter B Wu; Jorge Samanamud; Tamara Marie; Deborah Boyett; Tejaswi D Sudhakar; Sameer A Sheth; Guy M McKhann; Michael B Sisti; Jeffrey N Bruce; Peter Canoll; Jack Grinband Journal: Neuro Oncol Date: 2022-01-05 Impact factor: 13.029