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.
弥漫性低级别胶质瘤是一种浸润性肿瘤，其边界与邻近健康脑实质难以区分。本研究旨在精确评估术中宏观荧光技术在弥漫性低级别胶质瘤中的应用效果，并阐述能够指导低级别胶质瘤切除的新型荧光技术。仅约20%和50%的低级别胶质瘤在摄入5-氨基乙酰丙酸（5-ALA）或荧光素钠后分别呈现宏观荧光。然而，5-ALA有助于检测间变病灶，从而在弥漫性胶质瘤中选择最佳活检靶点。通过光谱检测5-ALA诱导的荧光，可探测到极低浓度且宏观不可见的原卟啉IX（5-ALA代谢产物），因此在低级别胶质瘤检测中表现出卓越性能。此外，这类肿瘤具有特定的光谱特征——双荧光发射峰，该特征不仅有助于区分肿瘤与健康脑组织，还能与高级别胶质瘤进行鉴别。共聚焦激光内镜显微技术可实现术中光学活检，但其灵敏度仍有限。未来，通过联合测量自体荧光与诱导荧光，并引入具备更宽视野的荧光检测技术，有望开发出适用于常规手术操作的便捷工具。
肿瘤(癌症)患者之家