KEY TAKEAWAYS
- The study aimed to evaluate the impact of 5-ALA and NaFl on diagnostic yield and complication rates in brain biopsies.
- The results showed NaFl’s greater diagnostic precision over 5-ALA, highlighting the need for further trials.
Stereotactic brain biopsies are highly effective for diagnosing intracerebral pathologies, including brain cancer, especially when surgical resection isn’t feasible. Fluorescence agents like 5-aminolevulinic acid (5-ALA) and fluorescein sodium (NaFl) can improve diagnostic accuracy and safety by enhancing the visualization of lesional tissues.
Fernando Cotrim Gomes and the team spearheaded a study that aimed to assess their impact on the diagnostic yield and complication rates of brain biopsies.
They followed Cochrane and PRISMA guidelines, evaluating studies for diagnostic yield and complication rates. Data were analyzed using a random-effects model in RStudio. Diagnostic accuracy, including sensitivity and predictive values, was calculated based on fluorescence visibility in biopsy samples.
Results showed that 32 non-randomized studies involving 947 patients, with a mean age of 37 to 77 years, were included. The average number of samples ranged from 1 to 15 specimens. Diagnostic yields were high, with 93% for NaFl and 96% for 5-ALA. Major complications occurred in 3% of procedures with both agents, while minor complications were reported in 7% for NaFl and 5% for 5-ALA.
The negative predictive value (NPV) was 8–11% for 5-ALA and 60–80% for NaFl. NaFl demonstrated higher sensitivity and specificity at 84% and 100%, compared to 5-ALA’s 66% and 85%, respectively.
The study concluded that 5-ALA and NaFl offer high diagnostic yields and acceptable safety profiles in stereotactic biopsies. NaFl demonstrated higher sensitivity and specificity, and it outperforms 5-ALA in NPV, making it more efficient for small lesions near critical regions or major blood vessels. Further randomized trials are needed to confirm these findings.
No funding was provided.
Source: https://link.springer.com/article/10.1007/s11060-024-04779-z
Gomes, F.C., Ferreira, M.Y., Larcipretti, A.L.L. et al.(2024).“Sodium fluorescein and 5-aminolevulinic acid fluorescence- guided biopsy in brain lesions: a systematic review and meta-analysis.” J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04779-z
