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Shah S, Ivey N, Matur A, Andaluz N. Intraoperative Fluorophores: An Update on 5-Aminolevulinic Acid and Sodium Fluorescein in Resection of Tumors of the Central Nervous System and Metastatic Lesions-A Systematic Review and Meta-Analysis. Tomography 2023; 9:1551-1567. [PMID: 37736977 PMCID: PMC10514891 DOI: 10.3390/tomography9050124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Recent advances in tumor visualization have improved the extent of resection (EOR) of primary and secondary tumors of the central nervous system, while limiting the morbidity and mortality of the surgery. One area of recent interest has been the use of intraoperative fluorophores for tumor visualization such as 5-aminolevulinic acid (5-ala) and sodium fluorescein. We performed a systematic review and meta-analysis on the utility of fluorophore administration and EOR with each fluorophore to update the current literature. METHODS We conducted a systematic review and meta-analysis on the use of intraoperative 5-ala or fluorescein between 2021 and 2023 using the PubMed, SCOPUS, and WOS databases. The initial search yielded 8688 results. After inclusion and exclusion criteria were met, 44 studies remained for review. A meta-analysis was performed to compare the EOR between studies for each fluorophore and to compare the presence of intraoperative fluorescence by tumor type. Odds ratios (OR) were calculated for gross total resection (GTR), and two-way ANOVA tests were performed to compare rates of intraoperative fluorescence by fluorophore and tumor type. RESULTS In all groups except low-grade glioma, fluorescence was present after 5-ala administration; fluorescence was present for all groups after fluorescein administration. Two-way ANOVA analysis for both fluorophores demonstrated no statistically significant difference in presence of fluorescence between type of tumor resected. Meta-analysis of EOR did show a higher, but not significant, rate of GTR in the 5-ala group compared to controls (OR = 1.29, 95% CI = 0.49; 3.37). In the fluorescein group, there were statistically significant higher odds of GTR compared to the control group (OR = 2.10, 95% CI = 1.43; 3.10, I2 = 0%). CONCLUSIONS Both 5-ala and sodium fluorescein demonstrated intraoperative fluorescence among various tumor types in both cranial and spinal tumors, as well as efficacy in improving EOR. Both fluorophores merit further investigation for use in surgery of CNS tumors.
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Affiliation(s)
- Sanjit Shah
- University of Cincinnati Medical Center, Cincinnati, OH 45209, USA
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Hosmann A, Millesi M, Wadiura LI, Kiesel B, Mercea PA, Mischkulnig M, Borkovec M, Furtner J, Roetzer T, Wolfsberger S, Phillips JJ, Berghoff AS, Hervey-Jumper S, Berger MS, Widhalm G. Reply to Stummer, W.; Thomas, C. Comment on "Hosmann et al. 5-ALA Fluorescence Is a Powerful Prognostic Marker during Surgery of Low-Grade Gliomas (WHO Grade II)-Experience at Two Specialized Centers. Cancers 2021, 13, 2540". Cancers (Basel) 2021; 13:5705. [PMID: 34830859 PMCID: PMC8616458 DOI: 10.3390/cancers13225705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
We greatly appreciate Dr. Stummer's and Dr. Thomas's interest in our study and their important comments [...].
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Affiliation(s)
- Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (M.M.); (L.I.W.); (B.K.); (P.A.M.); (M.M.); (M.B.); (S.W.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (A.S.B.)
| | - Matthias Millesi
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (M.M.); (L.I.W.); (B.K.); (P.A.M.); (M.M.); (M.B.); (S.W.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (A.S.B.)
| | - Lisa I. Wadiura
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (M.M.); (L.I.W.); (B.K.); (P.A.M.); (M.M.); (M.B.); (S.W.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (A.S.B.)
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (M.M.); (L.I.W.); (B.K.); (P.A.M.); (M.M.); (M.B.); (S.W.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (A.S.B.)
| | - Petra A. Mercea
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (M.M.); (L.I.W.); (B.K.); (P.A.M.); (M.M.); (M.B.); (S.W.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (A.S.B.)
| | - Mario Mischkulnig
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (M.M.); (L.I.W.); (B.K.); (P.A.M.); (M.M.); (M.B.); (S.W.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (A.S.B.)
| | - Martin Borkovec
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (M.M.); (L.I.W.); (B.K.); (P.A.M.); (M.M.); (M.B.); (S.W.)
| | - Julia Furtner
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Thomas Roetzer
- Comprehensive Cancer Center—Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (A.S.B.)
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (M.M.); (L.I.W.); (B.K.); (P.A.M.); (M.M.); (M.B.); (S.W.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (A.S.B.)
| | - Joanna J. Phillips
- Department of Pathology, University of California, San Francisco, CA 94143, USA;
| | - Anna S. Berghoff
- Comprehensive Cancer Center—Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (A.S.B.)
- Division of Oncology, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA; (S.H.-J.); (M.S.B.)
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA; (S.H.-J.); (M.S.B.)
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.H.); (M.M.); (L.I.W.); (B.K.); (P.A.M.); (M.M.); (M.B.); (S.W.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (A.S.B.)
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