Background: Fluorescence-guided surgery has been increasingly used to support glioma surgery with the purpose of obtaining a maximal safe resection, in particular in high-grade gliomas, while its role is less definitely assessed in low-grade gliomas. Methods: A systematic review was conducted. 5-aminolevulinic acid, sodium fluorescein, indocyanine green and tozuleristide were taken into account. The main considered outcome was the fluorescence rate, defined as the number of patients in whom positive fluorescence was detected out of the total number of patients. Only low-grade gliomas were considered, and data were grouped according to single fluorophores. Results: 16 papers about 5-aminolevulinic acid, 4 about sodium fluorescein, 2 about indocyanine green and 1 about tozuleristide were included in the systematic review. Regarding 5-aminolevulinic acid, a total of 467 low-grade glioma patients were included, and fluorescence positivity was detected in 34 out of 451 Grade II tumors (7.3%); while in Grade I tumors, fluorescence positivity was detected in 9 out of 16 cases. In 16 sodium fluorescein patients, seven positive fluorescent cases were detected. As far as indocyanine is concerned, two studies accounting for six patients (three positive) were included, while for tozuleristide, a single clinical trial with eight patients (two positive) was retrieved. Conclusions: The current evidence does not support the routine use of 5-aminolevulinic acid or sodium fluorescein with a standard operating microscope because of the low fluorescence rates. New molecules, including tozuleristide, and new techniques for fluorescence detection have shown promising results; however, their use still needs to be clinically validated on a large scale.
背景：荧光引导手术在胶质瘤手术中的应用日益广泛，旨在实现最大程度的安全切除，尤其在高级别胶质瘤中效果显著，但其在低级别胶质瘤中的作用尚未得到明确评估。方法：本研究进行了系统性文献综述，重点关注5-氨基乙酰丙酸、荧光素钠、吲哚菁绿及托珠利肽四种荧光剂。主要观察指标为荧光阳性率，即检测到阳性荧光的患者数占总患者数的比例。研究仅纳入低级别胶质瘤病例，并按不同荧光剂类型分组分析数据。结果：系统综述共纳入16篇关于5-氨基乙酰丙酸、4篇关于荧光素钠、2篇关于吲哚菁绿及1篇关于托珠利肽的研究。在5-氨基乙酰丙酸组中，共纳入467例低级别胶质瘤患者，451例II级肿瘤中检测到34例荧光阳性（7.3%）；16例I级肿瘤中检测到9例荧光阳性。荧光素钠组16例患者中检测到7例荧光阳性。吲哚菁绿组纳入两项研究共6例患者（3例阳性），托珠利肽组检索到一项包含8例患者（2例阳性）的临床试验。结论：现有证据不支持在标准手术显微镜下常规使用5-氨基乙酰丙酸或荧光素钠，因其荧光阳性率较低。包括托珠利肽在内的新型荧光分子及荧光检测技术已显示出良好前景，但其临床应用仍需大规模临床验证。
肿瘤(癌症)患者之家