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Histology of high-grade glioma samples resected using 5-ALA fluorescent headlight and loupe combination

  • Original Article - Tumor - Glioma
  • Published:
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Abstract

Purpose

5-Aminolevulinic acid (5-ALA) fluorescence-guided resection of high-grade gliomas (HGG) increases the extent of resection (EOR) and progression-free survival. The headlamp/loupe combination has been introduced as a method of performing fluorescent-guided surgery. This study aims to understand the correlation between fluorescent intensity and histology and between residual fluorescence and radiographic EOR utilizing the headlamp/loupe device.

Methods

Intraoperative samples resected using the headlamp/loupe device from 14 patients were labeled as PINK, VAGUE, or NEGATIVE depending on the degree of fluorescence. Histological assessment of microvascular proliferation, necrosis, and cell density was performed, and samples were classified as histologically consistent with glioblastoma (GBM), high-grade infiltrating glioma (HGIG), IG, or non-diagnostic (NDX). The presence of intraoperative residual fluorescence was compared to EOR on post-operative MRI.

Results

There was a significant difference in cell density comparing PINK, VAGUE, and NEGATIVE specimens (ANOVA, p < 0.00001). The PPV of PINK for GBM or HGIG was 88.4% (38/43). The NPV of NEGATIVE for IG or NDX was 74.4% (29/39). The relationship between the degree of fluorescence determination and histological results was significant (X2 (6 degrees of freedom, N = 101) = 42.57, p < 0.00001). The PPV of intraoperative GTR for post-operative GTR on MRI was 100%, while the NPV of intraoperative STR for post-operative STR on MRI was 60%.

Conclusion

The headlamp/loupe device provides information about histology, cell density, and necrosis with similar PPV for tumor to the operative microscope. Safe complete resection of florescence has a PPV of 100% for radiographic GTR and should be the goal of surgery.

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Abbreviations

5ALA:

5-Aminolevuilnic acid

EOR:

Extent of resection

GBM:

Glioblastoma

GTR:

Gross total resection

HGG:

High-grade gliomas

HGIG:

High-grade infiltrating glioma

MRI:

Magnetic resonance imaging

NDX:

Non-diagnostic

NPV:

Negative predictive value

PFS:

Progression-free survival

PPV:

Positive predictive value

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Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA

    Alexandra M. Giantini-Larsen, Natasha Kharas & Theodore H. Schwartz

  2. Department of Pathology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA

    David Pisapia

  3. Department of Neurosurgery, New York-Presbyterian Hospital, 525 East 68th Street, Box #99, New York, NY, 10065, USA

    Theodore H. Schwartz

Authors
  1. Alexandra M. Giantini-Larsen
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  2. Natasha Kharas
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  3. David Pisapia
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  4. Theodore H. Schwartz
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Corresponding author

Correspondence to Theodore H. Schwartz.

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Ethical approval

The study was approved by the Institutional Review Board (IRB) at our institution.

Consent to participate

All patients gave their informed consent to receive 5-ALA prior to resection.

Conflict of interest

The authors declare no competing interests.

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This article is part of the Topical Collection on Tumor—Glioma

This work has not been previously published. An abstract has been accepted for presentation to the Congress of Neurological Surgeons 2022 meeting.

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Giantini-Larsen, A.M., Kharas, N., Pisapia, D. et al. Histology of high-grade glioma samples resected using 5-ALA fluorescent headlight and loupe combination. Acta Neurochir 165, 567–575 (2023). https://doi.org/10.1007/s00701-023-05496-8

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  • DOI: https://doi.org/10.1007/s00701-023-05496-8

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