Correlation of Fluorescence Intensity with the Relative Proportion of Malignant Cells in the Tissue in 5-ALA-guided Resection of Glioblastoma

Authors: T. Krčík 1,2;  P. Buzrla 2,3;  K. Křivánková 4;  R. Lipina 1,2;  M. Smrčka 5
Authors‘ workplace: Neurochirurgická klinika LF OU a FN Ostrava 1;  LF OU v Ostravě 2;  Ústav patologie, FN Ostrava 3;  Radiodiagnostický ústav, FN Ostrava 4;  Neurochirurgická klinika LF MU a FN Brno 5
Published in: Cesk Slov Neurol N 2016; 79/112(3): 300-306
Category: Original Paper


To ascertain correlation between histological findings and the intensity of intraoperative fluorescence. During 5-aminolevulinic acid fluorescence-guided glioblastoma resection, three different levels of fluorescence intensity of the examined tissue can be distinguished in the operative field: 1. red, highly intensive fluorescence zone; 2. pink, moderately intensive fluorescence zone; 3. none, tissue without fluorescence.

Groups and methods:
A prospective study of 13 patients who underwent fluorescence-guided glioblastoma surgery. Representative specimens of the corresponding levels of fluorescence intensity were collected for histological examination. The semi-quantitative method was used to evaluation relative proportion of malignant cells in the tissue.

The histological examination from the highly intensive fluorescence zone biopsy samples revealed 75–100% proportion of malignant cells in the tissue. The infiltration reached 50–75% of the examined tissue in the moderately intensive fluorescence zone, and co-existence of glioblastoma and low grade glioma was noted in two cases. In six cases, there were no malignant cells in the negative fluorescence zone. However, seven specimens were positive for malignant cells, with the infiltration rate around 25% of the tissue. The correlation between the fluorescence intensity and the relative proportion of malignant cells in the tissue was statistically significant (p value < 0.001), and high positive predictive value of the fluorescence for the presence of malignant cells (PPV = 92%) was observed.

The intensity of intraoperative fluorescence correlates with the relative proportion of malignant cells in the tissue. The presence of malignant cells beyond observable fluorescence was confirmed in more than a half of the biopsy samples.

Key words:
glioblastoma – 5-aminolevulinic acid – fluorescence-guided resection – fluorescence intensity – histopathology

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


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