AB025. Efficacy of 5-ALA brightness analysis for malignant brain tumor surgery
Abstract

AB025. Efficacy of 5-ALA brightness analysis for malignant brain tumor surgery

Takashi Kon1, Yosuke Sato2, Yusuke Kobayashi1, Katsuyoshi Shimizu1, Tohru Mizutani1

1Department of Neurosurgery, Showa University, Tokyo, Japan; 2Brain Function Analysis and Digital Medicine Research Institute, Showa University, Tokyo, Japan

Correspondence to: Takashi Kon, MD. Department of Neurosurgery, Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. Email: TAKASHIKON@aol.com.

Background: For fluorescence-guided neurosurgery, 5-aminolevulinic acid (5-ALA) is widely used for intraoperative tumor visualization. We quantified the brightness of 5-ALA by Image J and report the pathological results of glioma, and non-tumor lesions.

Methods: From 2019 to 2023, we investigated 27 high-grade glioma patients who underwent surgery with 5-ALA. Twenty-three cases of glioblastoma (GBM) and four cases of anaplastic astrocytoma (AA) were examined. The pathological diagnosis was based on the classification of World Health Organization (WHO) 2016. The 5-ALA was administered before surgery, and the 5-ALA brightness was quantified. Other than high-grade glioma, four low-grade gliomas (LGGs), two radiation necrosis, and one inflammation patients were evaluated by Image J.

Results: In GBM, the mean brightness was 134.5±65.4, except for one negative case. AA showed the mean brightness with 180.5±51.6. All LGGs showed negative in the brightness. In two radiation necrosis cases, the mean brightness was 139.5±37.4. In one inflammatory case, the brightness was 239, but after the lesion removed, the adjacent brain parenchyma showed bright, and the border was not clear. In one GBM case, the ventricle was opened, and the brightness difference between the tumor and the ventricular wall was observed.

Conclusions: 5-ALA brightness analysis by Image J would be helpful to distinguish between malignant glioma and LGG, and other non-tumor lesions to support rapid pathological diagnosis. Also, it would be useful to distinguish between the tumor and the ventricle wall. As for radiation necrosis and inflammation, border of the lesion is unclear.

Keywords: 5-aminolevulinic acid (5-ALA); glioblastoma (GBM); fluorescence-assisted surgery

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cco.amegroups.com/article/view/10.21037/cco-24-ab025/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and approved by Showa University Oncology Institutional Review Board (IRB No. 21-074-B). Because of the retrospective nature of the research, the requirement for informed consent was waived.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Cite this abstract as: Kon T, Sato Y, Kobayashi Y, Shimizu K, Mizutani T. AB025. Efficacy of 5-ALA brightness analysis for malignant brain tumor surgery. Chin Clin Oncol 2024;13(Suppl 1):AB025. doi: 10.21037/cco-24-ab025

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