Background: One of the most valuable innovations in high-grade glioma surgery is 5-aminolevulinic acid (5-ALA). Fluorescence is a specific and sensitive indicator of metabolically active tumor tissue. In the published literature, the main focus has been placed on false-negative cases, with only a few articles addressing false positivity. The aim of the article was to highlight settings in which 5-ALA fluorescence does not necessarily mean tumor and to point out conditions in which intraoperative 5-ALA fluorescence has to be critically interpreted. Methods: Using PubMed, a review of pertinent literature was done to specifically investigate all conditions, including non-neoplastic and other metabolically active lesions, that can mimic high-grade gliomas and cause a misleading intraoperative diagnosis. In addition, an institutional case characterized by strong 5-ALA fluorescence in radionecrosis is presented. Results: Literature results were grouped in 2 main categories according to the field of application: oncologic setting (9 articles and 1 institutional case) and nononcologic settings (5 articles). Conclusions: As reported, 5-ALA-induced fluorescence is not limited to glioma but is also evident in nonglioma and non-neoplastic conditions. Critical interpretation of intraoperative fluorescence is therefore mandatory in recurrences and in atypical cases that might hinder alternative diagnoses.

La Rocca, G., Sabatino, G., Menna, G., Altieri, R., Ius, T., Marchese, E., Olivi, A., Barresi, V., Della Pepa, G. M., 5-Aminolevulinic Acid False Positives in Cerebral Neuro-Oncology: Not All That Fluorescent Is Tumor. A Case-Based Update and Literature Review, <<WORLD NEUROSURGERY>>, 2020; 137 (3): 187-193. [doi:10.1016/j.wneu.2020.01.238] [http://hdl.handle.net/10807/149108]

5-Aminolevulinic Acid False Positives in Cerebral Neuro-Oncology: Not All That Fluorescent Is Tumor. A Case-Based Update and Literature Review

Sabatino, G.;Marchese, E.;Olivi, A.;Della Pepa, G. M.
Ultimo
2020

Abstract

Background: One of the most valuable innovations in high-grade glioma surgery is 5-aminolevulinic acid (5-ALA). Fluorescence is a specific and sensitive indicator of metabolically active tumor tissue. In the published literature, the main focus has been placed on false-negative cases, with only a few articles addressing false positivity. The aim of the article was to highlight settings in which 5-ALA fluorescence does not necessarily mean tumor and to point out conditions in which intraoperative 5-ALA fluorescence has to be critically interpreted. Methods: Using PubMed, a review of pertinent literature was done to specifically investigate all conditions, including non-neoplastic and other metabolically active lesions, that can mimic high-grade gliomas and cause a misleading intraoperative diagnosis. In addition, an institutional case characterized by strong 5-ALA fluorescence in radionecrosis is presented. Results: Literature results were grouped in 2 main categories according to the field of application: oncologic setting (9 articles and 1 institutional case) and nononcologic settings (5 articles). Conclusions: As reported, 5-ALA-induced fluorescence is not limited to glioma but is also evident in nonglioma and non-neoplastic conditions. Critical interpretation of intraoperative fluorescence is therefore mandatory in recurrences and in atypical cases that might hinder alternative diagnoses.
Inglese
La Rocca, G., Sabatino, G., Menna, G., Altieri, R., Ius, T., Marchese, E., Olivi, A., Barresi, V., Della Pepa, G. M., 5-Aminolevulinic Acid False Positives in Cerebral Neuro-Oncology: Not All That Fluorescent Is Tumor. A Case-Based Update and Literature Review, <<WORLD NEUROSURGERY>>, 2020; 137 (3): 187-193. [doi:10.1016/j.wneu.2020.01.238] [http://hdl.handle.net/10807/149108]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/149108
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