Systematic review of fluorescence-guided surgery in pituitary neuroendocrine tumours.

Objective: Fluorescence-guided surgery represents a potential novel technique to improve the extent of tumour resection, minimise resection of normal tissue, and optimise outcomes in pituitary neuroendocrine tumour surgery. We systematically reviewed the available evidence on this topic to define the current role for fluorescence-guided surgery in this setting.

Design and methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. MEDLINE, EMBASE, and the Cochrane Library were searched on 1st March 2025 for studies investigating the use of exogenous fluorophores or autofluorescence in pituitary surgery. Two authors independently screened studies and extracted data from included studies. Risk of bias assessment was performed using the Newcastle-Ottawa Scale.

Results: From 1,604 studies identified, 22 studies involving 297 patients were included. Risk of bias was high in the vast majority of studies. Studies on six exogenous fluorophores were identified (indocyanine green, OTL38, bevacizumab-800CW, chlorin E6 photosensitiser, 5-aminolevulinic acid, and sodium fluorescein), with three studies assessing autofluorescence. Findings of included studies were variable, with small sample sizes and limited outcome reporting. 5-Aminolevulinic acid seems to have little use as a fluorophore in pituitary surgery. The clinical utility of the remaining fluorophores is not yet clearly defined. There are limited data on the utility of autofluorescence in pituitary surgery.

Conclusion: At present, there is insufficient evidence to support the routine use of fluorescence-guided surgery in this setting, prompting the need for further research in this area.