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    Home > Active Ingredient News > Antitumor Therapy > 5-ALA fluorescence display level is related to GBM histological characteristics

    5-ALA fluorescence display level is related to GBM histological characteristics

    • Last Update: 2020-06-02
    • Source: Internet
    • Author: User
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    Barbara Kiesel of the Medical University of Vienna, Austria, and others studied the correlation between GBM fluorescence visualization and tumorhistological characteristics, and the results were published in the August 2018 issue of J Neurosurg- From the articleRef:Kiesel B,et al.
    JNeurosurg.2018 Aug;129 (2):341-353doi: 10.3171/2017.4.JNS162991Epub 2017 Oct 27glioblastoma (glioblastoma, GBM) histology is significant, tumor morphology is variable, cell proliferation and microvascular proliferation is fastMinimizing GBM improves prognosis and is already the goal of most surgeonsThe visualization of the tumor can be improved by using midoperative fluorescence guidance of 5-aminolevulinic acid (5-aminolevulinic acid, 5-ALA)Depending on the fluorescence display level of the tumor during surgery, it can be distinguished into strong fluorescence, weak fluorescence and no fluorescence However, the correlation between fluorescence levels and tumor histology and surgery is still unclear Barbara Kiesel of the Medical University of Vienna in Austria and others studied the correlation between GBM fluorescence visualization and tumor histological characteristics, and the results were published in the August 2018 issue of the journal J Neurosurg the study included 77 new patients with pathologically confirmed GBM from 2008 to 2013 After imaging diagnosis, 5-ALA injections were received 3 hours before surgery, during which fluorescence was visualized through an surgical microscope The fluorescence levels of each tumor sample were recorded during the procedure Collected tumor samples histopathological results: including tissue mass (denseness, leaching or tumor-free), malignancy (cell density, nuclear polymorphism, nuclear division activity, microvascular hyperplasia or necrosis), proliferation rate i.e MIB-1 marker index (MIB-1 LI) and microvascular density (CD34 staining) (Figure 1) Figure 1 Cases of right frontal lobe GBM A At the beginning of the operation, the field of view of the tumor under the microscope; the strong fluorescence after B blue fluorescence; the corresponding pathological examination suggests dense tumors, high cell density, nuclear polymorphism, fissure activity, microvascular hyperplasia and necrosis; D rapid cell proliferation; E microvascular density high; F Another tumor field of view under the microscope; G Blue blue show weak fluorescence; H corresponding pathological tumor density, Medium form, low filamental activity, low microvascular proliferation but no necrosis; I medium cell proliferation rate; J microvascular density medium; K surgery will end with a view of the area of the impregnated tumor boundary under the microscope; L no fluorescence; M pathology suggests no clear tumor tissue, normal cell density and nuclear form, no filament and no micro-proliferation and necrosis; 267 tumor samples in 77 GBM tumors 131 tumor samples were strongly fluorescent, 69 were weak fluorescent and 67 were non-fluorescent The results of histopathological examination suggested that tumor tissue was detected in 131 (100%) samples in the strong fluorescent group and 65 (94%) in the weak fluorescent group The 33 (49%) samples in the non-fluorescent group contained invasive tumor tissue The 109 (83%) samples in the strong fluorescent group were dense tumor tissue The samples of 44 (64%) in the weak fluorescent group were in leaching tumor tissue The degree of tissue malignancy, including tumor cell density, nuclear polymorphism, nucleodivision activity, microvascular hyperplasia and necrosis, was positively correlated with fluorescence levels (p 0.001) In addition, the value-added rate was positively correlated with fluorescence levels, with 28.3% of MIB-1 LI in the strong fluorescence group, 16.7% for the weak fluorescence group MIB-1 LI, and 8.8% for the non-fluorescent group MIB-1 LI (p 0.001) The density of microvascular in the strong fluorescent group was significantly higher than that of the weak fluorescent group and the non-fluorescent group, and CD34 was 125.5 blood vessels/0.25mm 2 , 82.8 blood vessels/0.25mm 2 and 68.6 blood vessels/0.25mm 2 (p 0.001) finally the authors note that 5-ALA-induced tumor area fluorescence visualization can help neurosurgeons improve the level of removal of glioblastoma But half of non-fluorescent tissuestills still contain tumor tissue In the future, fluorescence spectroscopy may be required to solve the pathological differential diagnosis of non-fluorescent tissue samples.
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