Refining the Intraoperative Identification of Suspected High-Grade Glioma Using a Surgical Fluorescence Biomarker: GALA BIDD Study Report

Colin  Watts; Alimu  Dayimu; Tomasz  Matys; Keyoumars  Ashkan; Stephen  Price; Michael D.      Jenkinson; Gail  Doughton; Claire    Mather; Gemma  Young; Wendi  Qian; Kathreena M Kurian

doi:10.3390/jpm13030514

Refining the Intraoperative Identification of Suspected High-Grade Glioma Using a Surgical Fluorescence Biomarker: GALA BIDD Study Report

Colin Watts ^*, Alimu Dayimu , Tomasz Matys , Keyoumars Ashkan , Stephen Price , Michael D. Jenkinson, Gail Doughton , Claire Mather, Gemma Young , Wendi Qian , Kathreena M Kurian^*

^*Corresponding author for this work

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Abstract

Background. Improving intraoperative accuracy with a validated surgical biomarker is important because identifying high-grade areas within a glioma will aid neurosurgical decision-making and sampling.

Methods. We designed a multicentre, prospective surgical cohort study (GALA-BIDD) to validate the presence of visible fluorescence as a pragmatic intraoperative surgical biomarker of suspected high-grade disease within a tumour mass in patients undergoing 5-aminolevulinic acid (5-ALA) fluorescence-guided cytoreductive surgery.

Results. A total of 106 patients with a suspected high-grade glioma or malignant transformation of a low-grade glioma were enrolled. Among the 99 patients who received 5-ALA, 89 patients were eligible to assess the correlation of fluorescence with diagnosis as per protocol. Of these 89, 81 patients had visible fluorescence at surgery, and 8 patients had no fluorescence. A total of 80 out of 81 fluorescent patients were diagnosed as high-grade gliomas on postoperative central review with 1 low-grade glioma case. Among the eight patients given 5-ALA who did not show any visible fluorescence, none were high-grade gliomas, and all were low-grade gliomas. Of the seven patients suspected radiologically of malignant transformation of low-grade gliomas and with visible fluorescence at surgery, six were diagnosed with high-grade gliomas, and one had no tissue collected.

Conclusion. In patients where there is clinical suspicion, visible 5-ALA fluorescence has clinical utility as an intraoperative surgical biomarker of high-grade gliomas and can aid surgical decision-making and sampling. Further studies assessing the use of 5-ALA to assess malignant transformation in all diffuse gliomas may be valuable.

Original language	English
Article number	514
Number of pages	15
Journal	Journal of Personalized Medicine
Volume	13
Issue number	3
DOIs	https://doi.org/10.3390/jpm13030514
Publication status	Published - 13 Mar 2023

Bibliographical note

Funding Information:
This research was funded by Cancer Research UK ref C9221/A16700. This research was also supported by the NIHR Cambridge Biomedical Research Centre (NIHR203312). The views expressed are those of the authors and not necessarily those of the NIHR Department of Health and Social Care.

Publisher Copyright:
© 2023 by the authors.

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Watts , C., Dayimu , A., Matys , T., Ashkan , K., Price , S., Jenkinson, M. D., Doughton , G., Mather, C., Young , G., Qian , W., & Kurian, K. M. (2023). Refining the Intraoperative Identification of Suspected High-Grade Glioma Using a Surgical Fluorescence Biomarker: GALA BIDD Study Report . Journal of Personalized Medicine, 13(3), Article 514. https://doi.org/10.3390/jpm13030514

@article{6deba255d4f94c12807d32ce89d800b7,

title = "Refining the Intraoperative Identification of Suspected High-Grade Glioma Using a Surgical Fluorescence Biomarker: GALA BIDD Study Report ",

abstract = "Background. Improving intraoperative accuracy with a validated surgical biomarker is important because identifying high-grade areas within a glioma will aid neurosurgical decision-making and sampling. Methods. We designed a multicentre, prospective surgical cohort study (GALA-BIDD) to validate the presence of visible fluorescence as a pragmatic intraoperative surgical biomarker of suspected high-grade disease within a tumour mass in patients undergoing 5-aminolevulinic acid (5-ALA) fluorescence-guided cytoreductive surgery. Results. A total of 106 patients with a suspected high-grade glioma or malignant transformation of a low-grade glioma were enrolled. Among the 99 patients who received 5-ALA, 89 patients were eligible to assess the correlation of fluorescence with diagnosis as per protocol. Of these 89, 81 patients had visible fluorescence at surgery, and 8 patients had no fluorescence. A total of 80 out of 81 fluorescent patients were diagnosed as high-grade gliomas on postoperative central review with 1 low-grade glioma case. Among the eight patients given 5-ALA who did not show any visible fluorescence, none were high-grade gliomas, and all were low-grade gliomas. Of the seven patients suspected radiologically of malignant transformation of low-grade gliomas and with visible fluorescence at surgery, six were diagnosed with high-grade gliomas, and one had no tissue collected. Conclusion. In patients where there is clinical suspicion, visible 5-ALA fluorescence has clinical utility as an intraoperative surgical biomarker of high-grade gliomas and can aid surgical decision-making and sampling. Further studies assessing the use of 5-ALA to assess malignant transformation in all diffuse gliomas may be valuable. ",

author = "Colin Watts and Alimu Dayimu and Tomasz Matys and Keyoumars Ashkan and Stephen Price and Jenkinson, \{Michael D.\} and Gail Doughton and Claire Mather and Gemma Young and Wendi Qian and Kurian, \{Kathreena M\}",

note = "Funding Information: This research was funded by Cancer Research UK ref C9221/A16700. This research was also supported by the NIHR Cambridge Biomedical Research Centre (NIHR203312). The views expressed are those of the authors and not necessarily those of the NIHR Department of Health and Social Care. Publisher Copyright: {\textcopyright} 2023 by the authors.",

year = "2023",

month = mar,

day = "13",

doi = "10.3390/jpm13030514",

language = "English",

volume = "13",

journal = "Journal of Personalized Medicine",

issn = "2075-4426",

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Watts , C, Dayimu , A, Matys , T, Ashkan , K, Price , S, Jenkinson, MD, Doughton , G, Mather, C, Young , G, Qian , W & Kurian, KM 2023, 'Refining the Intraoperative Identification of Suspected High-Grade Glioma Using a Surgical Fluorescence Biomarker: GALA BIDD Study Report ', Journal of Personalized Medicine, vol. 13, no. 3, 514. https://doi.org/10.3390/jpm13030514

TY - JOUR

T1 - Refining the Intraoperative Identification of Suspected High-Grade Glioma Using a Surgical Fluorescence Biomarker

T2 - GALA BIDD Study Report

AU - Watts , Colin

AU - Dayimu , Alimu

AU - Matys , Tomasz

AU - Ashkan , Keyoumars

AU - Price , Stephen

AU - Jenkinson, Michael D.

AU - Doughton , Gail

AU - Mather, Claire

AU - Young , Gemma

AU - Qian , Wendi

AU - Kurian, Kathreena M

N1 - Funding Information: This research was funded by Cancer Research UK ref C9221/A16700. This research was also supported by the NIHR Cambridge Biomedical Research Centre (NIHR203312). The views expressed are those of the authors and not necessarily those of the NIHR Department of Health and Social Care. Publisher Copyright: © 2023 by the authors.

PY - 2023/3/13

Y1 - 2023/3/13

N2 - Background. Improving intraoperative accuracy with a validated surgical biomarker is important because identifying high-grade areas within a glioma will aid neurosurgical decision-making and sampling. Methods. We designed a multicentre, prospective surgical cohort study (GALA-BIDD) to validate the presence of visible fluorescence as a pragmatic intraoperative surgical biomarker of suspected high-grade disease within a tumour mass in patients undergoing 5-aminolevulinic acid (5-ALA) fluorescence-guided cytoreductive surgery. Results. A total of 106 patients with a suspected high-grade glioma or malignant transformation of a low-grade glioma were enrolled. Among the 99 patients who received 5-ALA, 89 patients were eligible to assess the correlation of fluorescence with diagnosis as per protocol. Of these 89, 81 patients had visible fluorescence at surgery, and 8 patients had no fluorescence. A total of 80 out of 81 fluorescent patients were diagnosed as high-grade gliomas on postoperative central review with 1 low-grade glioma case. Among the eight patients given 5-ALA who did not show any visible fluorescence, none were high-grade gliomas, and all were low-grade gliomas. Of the seven patients suspected radiologically of malignant transformation of low-grade gliomas and with visible fluorescence at surgery, six were diagnosed with high-grade gliomas, and one had no tissue collected. Conclusion. In patients where there is clinical suspicion, visible 5-ALA fluorescence has clinical utility as an intraoperative surgical biomarker of high-grade gliomas and can aid surgical decision-making and sampling. Further studies assessing the use of 5-ALA to assess malignant transformation in all diffuse gliomas may be valuable.

AB - Background. Improving intraoperative accuracy with a validated surgical biomarker is important because identifying high-grade areas within a glioma will aid neurosurgical decision-making and sampling. Methods. We designed a multicentre, prospective surgical cohort study (GALA-BIDD) to validate the presence of visible fluorescence as a pragmatic intraoperative surgical biomarker of suspected high-grade disease within a tumour mass in patients undergoing 5-aminolevulinic acid (5-ALA) fluorescence-guided cytoreductive surgery. Results. A total of 106 patients with a suspected high-grade glioma or malignant transformation of a low-grade glioma were enrolled. Among the 99 patients who received 5-ALA, 89 patients were eligible to assess the correlation of fluorescence with diagnosis as per protocol. Of these 89, 81 patients had visible fluorescence at surgery, and 8 patients had no fluorescence. A total of 80 out of 81 fluorescent patients were diagnosed as high-grade gliomas on postoperative central review with 1 low-grade glioma case. Among the eight patients given 5-ALA who did not show any visible fluorescence, none were high-grade gliomas, and all were low-grade gliomas. Of the seven patients suspected radiologically of malignant transformation of low-grade gliomas and with visible fluorescence at surgery, six were diagnosed with high-grade gliomas, and one had no tissue collected. Conclusion. In patients where there is clinical suspicion, visible 5-ALA fluorescence has clinical utility as an intraoperative surgical biomarker of high-grade gliomas and can aid surgical decision-making and sampling. Further studies assessing the use of 5-ALA to assess malignant transformation in all diffuse gliomas may be valuable.

U2 - 10.3390/jpm13030514

DO - 10.3390/jpm13030514

M3 - Article (Academic Journal)

C2 - 36983696

SN - 2075-4426

VL - 13

JO - Journal of Personalized Medicine

JF - Journal of Personalized Medicine

IS - 3

M1 - 514

ER -

Refining the Intraoperative Identification of Suspected High-Grade Glioma Using a Surgical Fluorescence Biomarker: GALA BIDD Study Report

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