5-Aminolevulinic acid is a promising marker for detection of anaplastic foci in diffusely infiltrating gliomas with nonsignificant contrast enhancement.
Background: Because of intratumoral heterogeneity, diffusely infiltrating gliomas that lack significant contrast enhancement on magnetic resonance imaging are prone to tissue sampling error. Subsequent histologic undergrading may delay adjuvant treatments. 5-Aminolevulinic acid (5-ALA) leads to accu...
| Publicado en: | Cancer (0008543X) Vol. 116; no. 6; pp. 1545 - 1553 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Wiley-Blackwell
3/15/2010
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105143302&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105143302 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0008543X 23I jtl: Cancer (0008543X) issn: 0008543X maglogo: Y pubinfo: dt: 3/15/2010 vid: 116 iid: 6 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 105143302 NLM20108311 2010592081 10.1002/cncr.24903 NLM20108311 105143302 ppf: 1545 ppct: 8 formats: tig: atl: 5-Aminolevulinic acid is a promising marker for detection of anaplastic foci in diffusely infiltrating gliomas with nonsignificant contrast enhancement. aug: au: Widhalm G Wolfsberger S Minchev G Woehrer A Krssak M Czech T Prayer D Asenbaum S Hainfellner JA Knosp E Widhalm, Georg Wolfsberger, Stefan Minchev, Georgi Woehrer, Adelheid Krssak, Martin Czech, Thomas Prayer, Daniela Asenbaum, Susanne Hainfellner, Johannes A Knosp, Engelbert affil: Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria sug: subj: Amino Acids Diagnostic Use Brain Neoplasms Radiography Glioma Radiography Tomography, Emission-Computed Methods Adult Aged Brain Neoplasms Pathology Brain Neoplasms Surgery Female Glioma Pathology Glioma Surgery Human Intraoperative Period Male Middle Age Photosensitizing Agents Diagnostic Use Tumor Markers, Biological Adult: 19-44 years Aged: 65+ years Middle Aged: 45-64 years Female Male ab: Background: Because of intratumoral heterogeneity, diffusely infiltrating gliomas that lack significant contrast enhancement on magnetic resonance imaging are prone to tissue sampling error. Subsequent histologic undergrading may delay adjuvant treatments. 5-Aminolevulinic acid (5-ALA) leads to accumulation of fluorescent porphyrins in malignant glioma tissue, and is currently used for resection of malignant gliomas. The aim of this study was to clarify whether 5-ALA might serve as marker for visualization of anaplastic foci in diffusely infiltrating gliomas with nonsignificant contrast enhancement for precise intraoperative tissue sampling. Methods: 5-ALA was administered in 17 patients with diffusely infiltrating gliomas with nonsignificant contrast enhancement. During glioma resection, positive fluorescence was noted by a modified neurosurgical microscope. Intraoperative topographic correlation of focal 5-ALA fluorescence with maximum (11)C-methionine positron emission tomography uptake (PET(max)) was performed. Multiple tissue samples were taken from areas of positive and/or negative 5-ALA fluorescence. Histopathological diagnosis was established according to World Health Organization (WHO) 2007 criteria. Cell proliferation was assessed for multiregional samples by MIB-1 labeling index (LI). Results: Focal 5-ALA fluorescence was observed in 8 of 9 patients with WHO grade III diffusely infiltrating gliomas. All 8 of 8 WHO grade II diffusely infiltrating gliomas were 5-ALA negative. Focal 5-ALA fluorescence correlated topographically with PET(max) in all patients. MIB-1 LI was significantly higher in 5-ALA-positive than in nonfluorescent areas within a given tumor. Conclusions: The data indicate that 5-ALA is a promising marker for intraoperative visualization of anaplastic foci in diffusely infiltrating gliomas with nonsignificant contrast enhancement. Unaffected by intraoperative brain shift, 5-ALA may increase the precision of tissue sampling during tumor resection for histopathological grading, and therefore optimize allocation of patients to adjuvant treatments. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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