5-Aminolevulinic acid-induced protoporphyrin IX fluorescence in meningioma: qualitative and quantitative measurements in vivo.
5-Aminolevulinic acid-induced protoporphyrin IX fluorescence in meningioma: qualitative and quantitative measurements in vivo.
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DOI：
10.1227/neu.0000000000000117
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发表时间：
2014-03
期刊：
影响因子：
4.8
通讯作者：
Roberts DW
中科院分区：
文献类型：
--
作者：
Valdes PA;Bekelis K;Harris BT;Wilson BC;Leblond F;Kim A;Simmons NE;Erkmen K;Paulsen KD;Roberts DW
使用5-氨基乙酰丙酸（ALA）诱导的原卟啉IX （PpIX）荧光已显示出作为手术辅助的希望，以最大限度地扩大胶质瘤的手术切除范围。迄今为止，5-ALA在脑膜瘤中的临床应用尚不完全清楚，大多数描述性研究使用5-ALA- ppix的定性方法。评价5-ALA-PpIX荧光在脑膜瘤手术切除中的诊断价值。我们对15例接受PpIX荧光引导手术的脑膜瘤患者进行了ALA治疗。在手术过程中的不同时刻，外科医生使用手术显微镜对荧光进行定性、视觉评估，然后使用术中探针进行定量荧光测量。在每个点采集标本用于随后的神经病理分析。方差聚类分析用于确定组间差异，并进行受试者操作特征分析以评估诊断能力。80%（12/15）的患者可见红粉色荧光，可见荧光普遍表现出强烈的均匀性。定量荧光检测在可见和非可见荧光组织中均检测到具有诊断意义的PpIX浓度（CPpIx），可见荧光组织（P < 0.001）和肿瘤组织（P = 0.002）中CPpIx浓度均显著升高。受者工作特征分析也显示，在区分肿瘤和正常硬脑膜方面的诊断准确率高达90%。ala诱导的PpIX荧光引导是脑膜瘤切除手术中准确检测肿瘤组织的潜在和有前途的辅助手段。这些结果表明PpIX作为脑膜瘤生物标志物的应用范围比以前文献中提到的要广泛。
The use of 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence has shown promise as a surgical adjunct for maximizing the extent of surgical resection in gliomas. To date, the clinical utility of 5-ALA in meningiomas is not fully understood, with most descriptive studies using qualitative approaches to 5-ALA-PpIX. To assess the diagnostic performance of 5-ALA-PpIX fluorescence during surgical resection of meningioma. ALA was administered to 15 patients with meningioma undergoing PpIX fluorescence-guided surgery at our institution. At various points during the procedure, the surgeon performed qualitative, visual assessments of fluorescence by using the surgical microscope, followed by a quantitative fluorescence measurement by using an intra-operative probe. Specimens were collected at each point for subsequent neuropathological analysis. Clustered data analysis of variance was used to ascertain a difference between groups, and receiver operating characteristic analyses were performed to assess diagnostic capabilities. Red-pink fluorescence was observed in 80% (12/15) of patients, with visible fluorescence generally demonstrating a strong, homogenous character. Quantitative fluorescence measured diagnostically significant PpIX concentrations (CPpIx) in both visibly and nonvisibly fluorescent tissues, with significantly higher CPpIx in both visibly fluorescent (P < .001) and tumor tissue (P = .002). Receiver operating characteristic analyses also showed diagnostic accuracies up to 90% for differentiating tumor from normal dura. ALA-induced PpIX fluorescence guidance is a potential and promising adjunct in accurately detecting neoplastic tissue during meningioma resective surgery. These results suggest a broader reach for PpIX as a biomarker for meningiomas than was previously noted in the literature.