Table 6.
Characteristics of studies assessing the performances of 5-ALA and FS for the resection of DLGGs.
| Study | Design | Effectives | Main Conclusions |
|---|---|---|---|
| 5-ALA | |||
| Sanai, 2011 [142] |
Prospective, monocentric in vivo + ex vivo |
10 gliomas, including 2 (20%) DLGGs | No macroscopic fluorescence. 100% in vivo and ex vivo fluorescence for superficial and tumor core samples. Perfect concordance with histopathological analysis for margin samples. |
| FLUORESCEIN SODIUM | |||
| Sanai, 2011 [153] |
Prospective, monocentric in vivo (WHO 2007) |
33 tumors, including 13 (39.4%) DLGGs | Feasibility study. Increase in surgical duration of 15–20 min. Correct identification of tumor margin. Morphological aspect consistent with histopathological sections. |
| Eschbacher, 2012 [145] | Prospective, monocentric In vivo (WHO 2007) |
50 tumors, including 8 (16%) DLGGs | Cell density and atypia well correlated with histological sections. Astrocytoma cells more elongated and atypical than oligodendroglioma cells. Blinded analysis: 4/4 (100%) accurate diagnosis for gliomas. |
| Martirosyan, 2016 [146] | Prospective, monocentric in vivo + ex vivo (WHO 2007) |
74 tumors, including 21 gliomas (8 DLGGs) |
Mean duration of 5.8 min per patient. Performances for detection of gliomas (all grade): Sensitivity = 91%, Specificity = 94%. Precise estimation of the grade not possible in all cases. |
| Pavlov, 2016 [147] |
Prospective, monocentric in vivo (WHO 2007) |
9 tumors, including 2 (22.2%) DLGGs Resection or biopsy |
Tumor detected in all cases but impossible to precisely estimate the grade, as expected criteria were not clearly identified (mitosis, endothelial proliferation, and necrosis). |
| Belykh, 2020 [148] |
Prospective, monocentric Ex vivo (WHO 2016) |
47 tumors, including 32 gliomas (3 DLGGs) | Performances for detection of gliomas, independently of the grade: Sensitivity = 66%, Specificity = 94%. Fluorescein Sodium re-injection: more pictures with accurate diagnosis (67% to 93%) and fewer non-diagnostic pictures (26% to 13%) |
| Höhne, 2021 [149] |
Retrospective, monocentric in vivo (WHO 2016) |
12 tumors, including 1 (8.3%) grade 2 oligodendroglioma | Macroscopic fluorescence visible at the tumor center and borders but not in the perilesional zone. Confirmation of abnormal aspects in these areas compared to adjacent brain. Timing of dye injection: no impact on picture quality. |
| Xu, 2022 [150] |
Re-analysis of 2 monocentric prospective series in vivo + ex vivo (WHO 2016) |
73 tumors, including 42 gliomas | Compared to ex vivo pictures, in vivo pictures have significantly higher brightness and contrast values and better diagnostic performances. For ex vivo pictures: negative correlation between contrast and time from dye injection. |
| Xu, 2024 [151] |
Retrospective, bicentric in vivo (WHO 2021) |
28 gliomas, including 2 (7.1%) DLGGs | Review of CLE pictures from resection margins Concordance of CLE and histological sections: 61.6%. CLE: Sensitivity = 79%, Specificity = 37% PPV = 65%, PNV = 53%. |
| Wagner, 2024 [152] |
Prospective, tricentric in vivo (WHO 2021) |
203 tumors, including 9 (4.4%) DLGGs and 77 (37.9%) HGGs | DLGGs Sensitivity: 56% (CLE) vs. 78% (frozen sections). Specificity: 99% (CLE) vs. 99% (frozen sections). HGGs Sensitivity: 86% (CLE) vs. 94% (frozen sections). Specificity: 95% (CLE) vs. 100% (frozen sections). Median assessment 3 min (CLE) vs. 27 min (frozen sections). |