ArticleNeuro-oncology2011
δ-aminolevulinic acid-induced protoporphyrin IX concentration correlates with histopathologic markers of malignancy in human gliomas: the need for quantitative fluorescence-guided resection to identify regions of increasing malignancy.
Article in Neuro-oncology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 87 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
87 citing papers in PubMed, 4 syntheses or guidelines pooled it, 159 citations in OpenAlex.
- Intraoperative fluorescence diagnosis in the brain: a systematic review and suggestions for future standards on reporting diagnostic accuracy and clinical utility.Acta neurochirurgica · 2019Pooled it
- Various shades of red-a systematic analysis of qualitative estimation of ALA-derived fluorescence in neurosurgery.Neurosurgical review · 2018Pooled it
- The role of 5-aminolevulinic acid in brain tumor surgery: a systematic review.Neurosurgical review · 2016Pooled it
- Pooled it
- Lower-grade gliomas surgery guided by GRPR-targeting PET/NIR dual-modality image probe: a prospective and single-arm clinical trial.Theranostics · 2024Trial
- Intraoperative fluorescence imaging with aminolevulinic acid detects grossly occult breast cancer: a phase II randomized controlled trial.Breast cancer research : BCR · 2021Trial
- Qualitative and quantitative assessment ofBiomedical optics express · 2026Article
- Quantification of dual-state 5-ALA-induced PpIX fluorescence: methodology and validation in tissue-mimicking phantoms.Physics in medicine and biology · 2026Article
- Effect of extending the oral administration period of 5-aminolevulinic acid on diagnostic accuracy and treatment outcomes for non-muscle-invasive bladder cancer.BJUI compass · 2026Article
- Pioneer of Biomedical Optics: Brian C. Wilson.Journal of biomedical optics · 2025Article
- EndoSCell: A portable intraoperative histopathological microscopy device for enhanced glioma resection and prognosis in animal models.APL bioengineering · 2025Article
- Clinical translation of photoacoustic imaging using exogenous molecular contrast agents [Invited].Biomedical optics express · 2025Review
- Enabling point of care optical diagnostics and treatment of oral lesions in resource-limited settings: Preclinical development and evaluation of a low-cost theranostic intraoral device for image-guided photodynamic therapy.Biophotonics discovery · 2025Article
- Review
- A Narrowband 635 nm Autofluorescence Peak in Albino Mouse Eyes Found With Multi-Modal Imaging Reveals the Presence of Protoporphyrin IX in the Choroid.Investigative ophthalmology & visual science · 2025Article
- Hyperspectral imaging in neurosurgery: a review of systems, computational methods, and clinical applications.Journal of biomedical optics · 2025Review
- Synthetic Efforts toward the Synthesis of a Fluorinated Analog of 5-Aminolevulinic Acid: Practical Synthesis of Racemic and Enantiomerically Defined 3-Fluoro-5-aminolevulinic Acid.The Journal of organic chemistry · 2024Article
- Review
- Recurrent Glioblastoma-Molecular Underpinnings and Evolving Treatment Paradigms.International journal of molecular sciences · 2024Review
- A handheld device for intra-cavity and ex vivo fluorescence imaging of breast conserving surgery margins with 5-aminolevulinic acid.BMC biomedical engineering · 2024Article
27 more citing papers are in PubMed but not listed here.
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Authors and funding
10 authors at 6 institutions in 2 countries.
Funding
Abstract
Extent of resection is a major goal and prognostic factor in the treatment of gliomas. In this study we evaluate whether quantitative ex vivo tissue measurements of δ-aminolevulinic acid-induced protoporphyrin IX (PpIX) identify regions of increasing malignancy in low- and high-grade gliomas beyond the capabilities of current fluorescence imaging in patients undergoing fluorescence-guided resection (FGR). Surgical specimens were collected from 133 biopsies in 23 patients and processed for ex vivo neuropathological analysis: PpIX fluorimetry to measure PpIX concentrations (C(PpIX)) and Ki-67 immunohistochemistry to assess tissue proliferation. Samples displaying visible levels of fluorescence showed significantly higher levels of C(PpIX) and tissue proliferation. C(PpIX) was strongly correlated with histopathological score (nonparametric) and tissue proliferation (parametric), such that increasing levels of C(PpIX) were identified with regions of increasing malignancy. Furthermore, a large percentage of tumor-positive biopsy sites (∼40%) that were not visibly fluorescent under the operating microscope had levels of C(PpIX) greater than 0.1 µg/mL, which indicates that significant PpIX accumulation exists below the detection threshold of current fluorescence imaging. Although PpIX fluorescence is recognized as a visual biomarker for neurosurgical resection guidance, these data show that it is quantitatively related at the microscopic level to increasing malignancy in both low- and high-grade gliomas. This work suggests a need for improved PpIX fluorescence detection technologies to achieve better sensitivity and quantification of PpIX in tissue during surgery.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.