title: Fluorescence-guided resection of high-grade gliomas: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The present systematic review and meta-analysis was to analyze of the advantages of intraoperative fluorescence-guided resection of high-grade gliomas.
  
  
  METHODS
  Systematic computerized searches of the PubMed and Web of Knowledge were performed. The outcomes included diagnostic value for identification of tumor tissue, gross total resection, and prognosis. The summary receiver operating characteristic curves (SROC), the pooled sensitivities, the pooled specificities, the pooled odd ratio (OR) and the pooled hazard ratio (HR) were estimated by meta-analysis.
  
  
  RESULTS
  Twelve studies were included. The pooled sensitivity and the pooled specificity for identification of tumor tissue was 0.84 (95% CI: 0.81-0.87), and 0.91 (95% CI: 0.87-0.94), respectively. And the overall weighted AUC of the SROC curve was 0.9520 ± 0.0116. The summary OR of the gross total resection rate in patients with fluorescein-guided resection compared with patients with no fluorescein was 4.372 (95% CI 2.937-6.508). Fluorescein-guided resection was associated with a reduced risk of progression-free survival compared with no fluorescein, with HR 0.73 (95% CI 0.57-0.94, P = 0.01). The pooled HR of overall survival was 1.000 (95% CI 0.960-1.040) between two groups. No significant publication bias was found.
  
  
  CONCLUSIONS
  Fluorescence-guided resection of high-grade gliomas is effective for diagnosing tumor margins, increasing gross total resection, and reducing the risk of progression-free survival. But this conclusion should be confirmed by large sample randomized controlled clinical trials.
authors.affiliation: Department of Neurosurgery, Affiliated Hospital of Nantong University, Xi Si Road 20#, Nantong City, Jiangsu Province, PR China.
authors.forename: Xing
authors.initials: X
authors.lastname: Su
authors.affiliation: Department of Neurosurgery, Affiliated Hospital of Nantong University, Xi Si Road 20#, Nantong City, Jiangsu Province, PR China. Electronic address: hqf025@163.com.
authors.forename: Qing-Feng
authors.initials: QF
authors.lastname: Huang
authors.affiliation: Nantong University, Qixiu Road 19#, Nantong city, Jiangsu province, PR China.
authors.forename: Hong-Lin
authors.initials: HL
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Affiliated Hospital of Nantong University, Xi Si Road 20#, Nantong City, Jiangsu Province, PR China. Electronic address: pphss@126.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005456:Fluorescent Dyes / Q000627:therapeutic use; D005910:Glioma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008856:Microscopy, Fluorescence / Q000706:statistics & numerical data*; D060787:Neoplasm Grading; D015995:Prevalence; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000379:methods / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D005456:Fluorescent Dyes
keywords: Fluorescence-guided resection; Gliomas; Meta-analysis