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

TitleHistology of high-grade glioma samples resected using 5-ALA fluorescent headlight and loupe combination.
Publication TypeJournal Article
Year of Publication2023
AuthorsGiantini-Larsen AM, Kharas N, Pisapia D, Schwartz TH
JournalActa Neurochir (Wien)
Date Published2023 Feb
KeywordsAminolevulinic Acid, Brain Neoplasms, Coloring Agents, Glioblastoma, Glioma, Humans, Surgery, Computer-Assisted

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.

Alternate JournalActa Neurochir (Wien)
PubMed ID36656388
Related Faculty: 
David Pisapia, M.D.

Pathology & Laboratory Medicine 1300 York Avenue New York, NY 10065 Phone: (212) 746-6464
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