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Review
. 2024 Jul 29;16(15):2698.
doi: 10.3390/cancers16152698.

Fluorescence-Guided Surgical Techniques in Adult Diffuse Low-Grade Gliomas: State-of-the-Art and Emerging Techniques: A Systematic Review

Thiebaud Picart  1   2   3 , Arthur Gautheron  4   5 , Charly Caredda  5 , Cédric Ray  5 , Laurent Mahieu-Williame  5 , Bruno Montcel  5 , Jacques Guyotat  1   2   5
Affiliations
Review

Fluorescence-Guided Surgical Techniques in Adult Diffuse Low-Grade Gliomas: State-of-the-Art and Emerging Techniques: A Systematic Review

Thiebaud Picart et al. Cancers (Basel). .

Abstract

Diffuse low-grade gliomas are infiltrative tumors whose margins are not distinguishable from the adjacent healthy brain parenchyma. The aim was to precisely examine the results provided by the intraoperative use of macroscopic fluorescence in diffuse low-grade gliomas and to describe the new fluorescence-based techniques capable of guiding the resection of low-grade gliomas. Only about 20% and 50% of low-grade gliomas are macroscopically fluorescent after 5-amino-levulinic acid (5-ALA) or fluorescein sodium intake, respectively. However, 5-ALA is helpful for detecting anaplastic foci, and thus choosing the best biopsy targets in diffuse gliomas. Spectroscopic detection of 5-ALA-induced fluorescence can detect very low and non-macroscopically visible concentrations of protoporphyrin IX, a 5-ALA metabolite, and, consequently, has excellent performances for the detection of low-grade gliomas. Moreover, these tumors have a specific spectroscopic signature with two fluorescence emission peaks, which is useful for distinguishing them not only from healthy brain but also from high-grade gliomas. Confocal laser endomicroscopy can generate intraoperative optic biopsies, but its sensitivity remains limited. In the future, the coupled measurement of autofluorescence and induced fluorescence, and the introduction of fluorescence detection technologies providing a wider field of view could result in the development of operator-friendly tools implementable in the operative routine.

Keywords: 5-ALA; biopsy; confocal laser endomicroscopy; diffuse low-grade gliomas; fluorescein sodium; fluorescence-guided resection; spectroscopy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Standard PRISMA flow diagram.
Figure 2
Figure 2
Mechanisms leading to tumor detection using 5-ALA (partly created with Biorender).
Figure 3
Figure 3
Summary of results provided by macroscopic fluorescence-guided surgery in DLGGs and emerging new intraoperative techniques able to challenge the current limitations (partly created with Biorender).
See this image and copyright information in PMC

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