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Acta Neurochirurgica

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01-02-2018 | Original Article - Neurosurgical Techniques

Investigation of the usefulness of fluorescein sodium fluorescence in stereotactic brain biopsy

Authors: Ady Thien, Julian Xinguang Han, Krishan Kumar, Yew Poh Ng, Jai Prashanth Rao, Wai Hoe Ng, Nicolas Kon Kam King

Published in: Acta Neurochirurgica | Issue 2/2018

Abstract

Background

Intraoperative frozen section assessment, to confirm acquisition of pathological tissues, is used in stereotactic brain biopsy to minimise sampling errors. Limitations include the dependence on dedicated neuro-oncology pathologists and an increase in operative duration. We investigated the use of intraoperative fluorescein sodium, and compared it to frozen section assessment, for confirming pathological tissue samples in the stereotactic biopsy of gadolinium-contrast-enhancing brain lesions.

Methods

This prospective observational study consisted of 18 consecutive patients (12 men; median age, 63 years) who underwent stereotactic biopsy of gadolinium-contrast-enhancing brain lesions with intravenous fluorescein sodium administration. Twenty-three specimens were obtained and examined for the presence of fluorescence using a microscope with fluorescence visualisation capability. Positive and negative predictive values were calculated based on the fluorescence status of the biopsy samples with its corresponding intraoperative frozen section and definitive histopathological diagnosis.

Results

Nineteen specimens (83%) were fluorescent and four (17%) were non-fluorescent. All 19 fluorescent specimens were confirmed to be lesional on intraoperative frozen section assessment and were suitable for histopathological diagnosis. Three of the non-fluorescent specimens were confirmed to be lesional on intraoperative frozen section assessment. One non-fluorescent specimen was non-diagnostic on frozen section and histological assessments. The positive predictive value was 100% and the negative predictive value was 25%.

Conclusions

Fluorescein sodium fluorescence is as accurate as frozen section assessment in confirming sampling of pathological tissue in the stereotactic biopsy of gadolinium-contrast-enhancing brain lesions. Fluorescein sodium fluorescence-guided stereotactic biopsy is a useful addition to the neurosurgical armamentarium.

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Title: Investigation of the usefulness of fluorescein sodium fluorescence in stereotactic brain biopsy
Authors: Ady Thien
Julian Xinguang Han
Krishan Kumar
Yew Poh Ng
Jai Prashanth Rao
Wai Hoe Ng
Nicolas Kon Kam King
Publication date: 01-02-2018
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 2/2018
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-017-3429-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Investigation of the usefulness of fluorescein sodium fluorescence in stereotactic brain biopsy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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