5-Aminolevulinic Acid False Positives in Cerebral Neuro-Oncology: Not All That Is Fluorescent Is Tumor. A Case-Based Update and Literature Review.

Abstract

BACKGROUND:

One of the most valuable innovations in high-grade glioma surgery is 5-aminolevulinic acid (5-ALA). Fluorescence is a specific and sensitive indicator of metabolically active tumor tissue. In the published literature, the main focus has been placed on false-negative cases, with only a few articles addressing false positivity. The aim of the article was to highlight settings in which 5-ALA fluorescence does not necessarily mean tumor and to point out conditions in which intraoperative 5-ALA fluorescence has to be critically interpreted.

METHODS:

Using PubMed, a review of pertinent literature was done to specifically investigate all conditions, including non-neoplastic and other metabolically active lesions, that can mimic high-grade gliomas and cause a misleading intraoperative diagnosis. In addition, an institutional case characterized by strong 5-ALA fluorescence in radionecrosis is presented.

RESULTS:

Literature results were grouped in 2 main categories according to the field of application: oncologic setting (9 articles and 1 institutional case) and nononcologic settings (5 articles).

CONCLUSIONS:

As reported, 5-ALA-induced fluorescence is not limited to glioma but is also evident in nonglioma and non-neoplastic conditions. Critical interpretation of intraoperative fluorescence is therefore mandatory in recurrences and in atypical cases that might hinder alternative diagnoses.

• Authors: Giuseppe La Rocca, Giovanni Sabatino, Grazia Menna, Roberto Altieri, Tamara Ius, Enrico Marchese, Alessandro Olivi, Valeria Barresi, Giuseppe Maria Della Pepa
• Journal: World neurosurgery (World Neurosurg) Vol. 137 Pg. 187-193 (05 2020) ISSN: 1878-8769 [Electronic] United States
• PMID: 32058110 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Chemical References

• Fluorescent Dyes
• Aminolevulinic Acid

Topics

• Aminolevulinic Acid
• Brain Neoplasms (diagnosis, therapy)
• Chemoradiotherapy, Adjuvant
• Diagnostic Errors
• False Positive Reactions
• Female
• Fluorescent Dyes
• Glioma (diagnosis, surgery)
• Humans
• Intraoperative Care
• Middle Aged
• Necrosis
• Neoplasm Recurrence, Local (diagnosis)
• Neurosurgical Procedures
• Oligodendroglioma (diagnosis, therapy)
• Radiation Injuries (diagnosis, pathology, surgery)