Fluorescence-Guided Surgery to Detect Microscopic Disease in Ovarian Cancer: A Systematic Review with Meta-Analysis

The identification of tumors during cytoreductive surgery relies on visual inspection, palpation, or blind biopsy methods that exhibit limited reliability in detecting microscopic disease. Fluorescence-guided surgery (FGS) utilizes various tracers for the identification of microscopic disease. The objective of this study was to evaluate the efficacy of FGS in the detection of microscopic disease through meta-analyses, while discussing the existing evidence and potential implications for ovarian cancer. The pooled odds ratio of a change in surgical plan/microscopic disease for FGS, standard techniques, and peritonectomy was 1.29 and 1.14, respectively. Among the FGS tracers, folate receptors exhibited high sensitivity; however, their low specificity resulted in false positives. 5-Aminolevulinic acid exhibited high sensitivity (84%) and specificity (96%) in detecting microscopic disease. Standardized protocols and phase III trials are essential to determine the role of FGS in ovarian cancer. We discuss the significant variability in existing studies, the limitations of FGS, and the potential implications for future research.