Refining the Intraoperative Identification of Suspected High-Grade Glioma Using a Surgical Fluorescence Biomarker:...

Area of Science:

• Neurosurgery
• Oncology
• Medical Imaging

Background:

• Accurate intraoperative identification of high-grade glioma areas is crucial for effective neurosurgical decision-making and tissue sampling.
• Validated surgical biomarkers are needed to improve diagnostic accuracy during glioma surgery.

Purpose of the Study:

• To validate visible fluorescence as an intraoperative surgical biomarker for suspected high-grade glioma.
• To assess the utility of 5-aminolevulinic acid (5-ALA) fluorescence in guiding cytoreductive surgery.

Main Methods:

• A multicentre, prospective surgical cohort study (GALA-BIDD) was conducted.
• Patients undergoing 5-ALA fluorescence-guided surgery were enrolled to correlate fluorescence with tumor grade.
• Correlation between visible fluorescence and postoperative pathological diagnosis was analyzed.

Main Results:

• Of 89 eligible patients receiving 5-ALA, 81 showed visible fluorescence and were predominantly diagnosed with high-grade gliomas (80/81).
• Eight patients without visible fluorescence were all diagnosed with low-grade gliomas.
• Visible fluorescence in suspected malignant transformation cases accurately predicted high-grade gliomas (6/7).

Conclusions:

• Visible 5-ALA fluorescence serves as a clinically useful intraoperative biomarker for high-grade gliomas in patients with clinical suspicion.
• 5-ALA fluorescence aids surgical decision-making and improves tumor sampling.
• Further research into 5-ALA for assessing malignant transformation in diffuse gliomas is warranted.