新疆医科大学第一附属医院神经外科，新疆 乌鲁木齐 830000
夏鸣（1993—），男，在读硕士，住院医师，主要从事中枢神经系统肿瘤的研究，Email: Charlth_xia@163.com。
周庆九（1969—），男，博士，主任医师，主要从事中枢神经系统肿瘤的研究，Email: zhouqingjiu007@163.com。
Department of Neurosurgery， the First Affiliated Hospital， Xinjiang Medical University， Urumqi 830000 China
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目的 探究不同病理类型胶质瘤在术中应用荧光素钠后判断胶质瘤边界效能的差别。方法 使用诊断试验的方法选取新疆医科大学第一附属医院神经外科2020年1月—2020年6月使用荧光素钠术中显影的胶质瘤的患者，术中取荧光显微镜下黄染区和附近非黄染区（黄染区外约5 mm）分别进行病理检查，统计并绘制ROC曲线，对比术中使用荧光素钠对不同病理来源的胶质瘤的诊断效率。结果 患者共有52例。其中，男性31例，女性21例；平均年龄（46±16）岁；肿瘤为星形胶质细胞来源34例，少突胶质细胞来源18例。荧光素钠显示高级别胶质瘤边界的可靠性和真实性优于显示肿瘤边界（灵敏度98% vs 73%，特异度89% vs 97%，Kappa值0.86（>0.80几乎完全一致） vs 0.63（>0.60高度的一致性），约登指数0.87 vs 0.71）。荧光素钠显示星形细胞瘤边界的可靠性和真实性优于显示少突胶质细胞瘤边界（灵敏度84%vs57%，特异度78% vs 83%，Kappa值0.61（>0.60高度的一致性） vs 0.22（>0.21一致性一般），约登指数0.62 vs 0.40）。结论 术中使用荧光素钠确定肿瘤边界时，在黄染边界5 mm范围内，当肿瘤为星形胶质细胞来源时荧光所示边界可以认为是肿瘤边界；当肿瘤为少突胶质细胞来源时该边界不能认为是肿瘤边界。 [引用格式:国际神经病学神经外科学杂志, 2021, 48(4): 354-358.]
Objective To investigate the performance of sodium fluorescein in intraoperative judgment of glioma boundary in different pathological types of glioma.Methods The diagnosis test was performed to select the patients with glioma who underwent intraoperative imaging with sodium fluorescein in Department of Neurosurgery， The First Affiliated Hospital of Xinjiang Medical University， from January to June 2020. Samples of the yellow-stained area and the nearby non-yellow-stained area （about 5 mm outside the yellow-stained area） under a fluorescence microscope were collected for pathological examination， and a statistical analysis was performed and the receiver operating characteristic curve was plotted to compare the accuracy of sodium fluorescein in the diagnosis of glioma with different pathological sources.Results A total of 52 patients were enrolled， among whom there were 31 male patients and 21 female patients， with a mean age of 46±16 years. Among these 52 patients， 34 had tumor originating from astrocytes and 18 had tumor originating from oligodendrocytes. Sodium fluorescein showed higher reliability and authenticity in displaying the boundary of high-grade glioma than tumor boundary （sensitivity： 98% vs 73%； specificity： 89% vs 97%； Kappa value 0.86 （>0.80 almost identical） vs 0.63 （>0.60 high consistency）； Youden index： 0.87 vs 0.71）. Sodium fluorescein showed higher reliability and authenticity in displaying the boundary of astrocyte-derived gliomas than that of oligodendrocyte-derived gliomas （sensitivity： 84% vs 57%； specificity： 78% vs 83%； Kappa value 0.61 （>0.60 high consistency） vs 0.22 （>0.21 general consistency）； Youden index： 0.62 vs 0.40）.Conclusions When sodium fluorescein is used to determine tumor boundary during surgery within 5 mm of the yellow-stained boundary， the boundary displayed by fluorescence can be regarded as tumor boundary when the tumor is derived from astrocytes， while this boundary cannot be defined as tumor boundary when the tumor is derived from oligodendrocytes. ［Citation:Journal of International Neurology and Neurosurgery， 2021， 48（4）： 354-358.］
引用本文
夏鸣,付强,李绍山,刘波,周庆九456.荧光素钠在术中判断胶质瘤边界的研究[J].国际神经病学神经外科学杂志,2021,48(4):354-358111XIA Ming, FU Qiang, Li Shao-Shan, LIU Bo, ZHOU Qing-Jiu222. Value of sodium fluorescein in assisting intraoperative judgment of glioma boundary[J]. Journal of International Neurology and Neurosurgery,2021,48(4):354-358
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- 收稿日期:2021-02-05
- 最后修改日期:2021-07-09
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- 在线发布日期: 2021-09-23
