ArticleNeurosurgery2016
The Value of 5-Aminolevulinic Acid in Low-grade Gliomas and High-grade Gliomas Lacking Glioblastoma Imaging Features: An Analysis Based on Fluorescence, Magnetic Resonance Imaging, 18F-Fluoroethyl Tyrosine Positron Emission Tomography, and Tumor Molecular Factors.
Article in Neurosurgery, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 88 papers, 6 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.
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Who cites it
88 citing papers in PubMed, 6 syntheses or guidelines pooled it, 141 citations in OpenAlex.
- Prognostic revalidation of RANO categories for extent of resection in glioblastoma: a reconstruction of individual patient data.Journal of neuro-oncology · 2025Pooled it
- Intraoperative Fluorophores: An Update on 5-Aminolevulinic Acid and Sodium Fluorescein in Resection of Tumors of the Central Nervous System and Metastatic Lesions-A Systematic Review and Meta-Analysis.Tomography (Ann Arbor, Mich.) · 2023Pooled it
- Resection of the contrast-enhancing tumor in diffuse gliomas bordering eloquent areas using electrophysiology and 5-ALA fluorescence: evaluation of resection rates and neurological outcome-a systematic review and meta-analysis.Neurosurgical review · 2023Pooled it
- 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
- Fluorescence guided surgery by 5-ALA and intraoperative MRI in high grade glioma: a systematic review.Journal of neuro-oncology · 2019Pooled it
- Survival Outcomes Among Patients With High-Grade Glioma Treated With 5-Aminolevulinic Acid-Guided Surgery: A Systematic Review and Meta-Analysis.Frontiers in oncology · 2019Pooled it
- Lower-grade gliomas surgery guided by GRPR-targeting PET/NIR dual-modality image probe: a prospective and single-arm clinical trial.Theranostics · 2024Trial
- Effects of 5-ALA dose on resection of glioblastoma.Journal of neuro-oncology · 2019Trial
- First-in-human study of PET and optical dual-modality image-guided surgery in glioblastoma usingTheranostics · 2018Trial
- Randomized, Prospective Double-Blinded Study Comparing 3 Different Doses of 5-Aminolevulinic Acid for Fluorescence-Guided Resections of Malignant Gliomas.Neurosurgery · 2017Trial
- Intraoperative technological advances and new frontiers in precision glioma surgery.Journal of neuro-oncology · 2026Review
- Preoperative prediction of 5-ALA fluorescence in gliomas: comparison of 7-Tesla magnetic resonance spectroscopic imaging, contrast-enhancement on MRI, and positron emission tomography.European radiology · 2026Article
- MIB-1 index predicts low recurrence risk after subtotal resection of meningiomas: a retrospective study of 505 patients.Neurosurgical review · 2026Article
- Quantification of dual-state 5-ALA-induced PpIX fluorescence: methodology and validation in tissue-mimicking phantoms.Physics in medicine and biology · 2026Article
- Prognostic value of [European journal of nuclear medicine and molecular imaging · 2026Article
- Machine-Learning-Enabled Raman Spectroscopy Refines Indocyanine Green Fluorescence Boundaries for Precise Glioblastoma Margin Delineation.Research (Washington, D.C.) · 2026Article
- Prognostic value of MIB-1 index in meningioma: a retrospective cohort study to establish an optimal cutoff for recurrence and survival.Journal of neuro-oncology · 2025Article
- Review
- Review
- Advancing Glioma Management: The Pivotal Role of Surgical Neuro-Oncology in Driving Innovation and Translational Research.Current oncology reports · 2025Review
28 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundApproximately 20% of grade II and most grade III gliomas fluoresce after 5-aminolevulinic acid (5-ALA) application. Conversely, approximately 30% of nonenhancing gliomas are actually high grade.
objectiveThe aim of this study was to identify preoperative factors (ie, age, enhancement, 18F-fluoroethyl tyrosine positron emission tomography [F-FET PET] uptake ratios) for predicting fluorescence in gliomas without typical glioblastomas imaging features and to determine whether fluorescence will allow prediction of tumor grade or molecular characteristics.
methodsPatients harboring gliomas without typical glioblastoma imaging features were given 5-ALA. Fluorescence was recorded intraoperatively, and biopsy specimens collected from fluorescing tissue. World Health Organization (WHO) grade, Ki-67/MIB-1 index, IDH1 (R132H) mutation status, O-methylguanine DNA methyltransferase (MGMT) promoter methylation status, and 1p/19q co-deletion status were assessed. Predictive factors for fluorescence were derived from preoperative magnetic resonance imaging and F-FET PET. Classification and regression tree analysis and receiver-operating-characteristic curves were generated for defining predictors.
resultsOf 166 tumors, 82 were diagnosed as WHO grade II, 76 as grade III, and 8 as glioblastomas grade IV. Contrast enhancement, tumor volume, and F-FET PET uptake ratio >1.85 predicted fluorescence. Fluorescence correlated with WHO grade (P < .001) and Ki-67/MIB-1 index (P < .001), but not with MGMT promoter methylation status, IDH1 mutation status, or 1p19q co-deletion status. The Ki-67/MIB-1 index in fluorescing grade III gliomas was higher than in nonfluorescing tumors, whereas in fluorescing and nonfluorescing grade II tumors, no differences were noted.
conclusionAge, tumor volume, and F-FET PET uptake are factors predicting 5-ALA-induced fluorescence in gliomas without typical glioblastoma imaging features. Fluorescence was associated with an increased Ki-67/MIB-1 index and high-grade pathology. Whether fluorescence in grade II gliomas identifies a subtype with worse prognosis remains to be determined.
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