Diagnostic yield of fluorescence-assisted frame-based stereotactic biopsies of intracerebral lesions in comparison with
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CLINICAL STUDY
Diagnostic yield of fluorescence‑assisted frame‑based stereotactic biopsies of intracerebral lesions in comparison with frozen‑section analysis Vesna Malinova1 · Kajetan von Eckardstein1,2 · Dorothee Mielke1 · Veit Rohde1 Received: 30 April 2020 / Accepted: 23 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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 frozensection 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-ALApositive samples were obtained in 74.3% (29/39) of patients and all these samples contained diagnostic tissue. 5-ALAfluorescence 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. Keywords Frame-based stereotactic biopsy · 5-ALA-fluorescence · Frozen section analysis
Introduction Histological diagnosis confirmation of unclear intracerebral lesions is essential for the initiation of an appropriate treatment. Frame-based and frameless stereotactic techniques are routinely used for taking biopsies from unclear cerebral * Vesna Malinova [email protected] 1
Department of Neurosurgery, Georg-August-University Göttingen, Robert‑Koch‑Straße 40, 37075 Göttingen, Germany
Department of Neurosurgery, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
2
pathologies [1, 2]. The main surgical goal of these procedures is
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