In vivo fluorescence navigation of gastric and upper gastrointestinal tumors by 5-aminolevulinic acid mediated photodynamic diagnosis with a laser-equipped video image endoscope
In vivo fluorescence navigation of gastric and upper gastrointestinal tumors by 5-aminolevulinic acid mediated photodynamic diagnosis with a laser-equipped video image endoscope
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DOI：
10.1016/j.pdpdt.2015.03.006
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发表时间：
2015-06-01
影响因子：
3.3
通讯作者：
Nakao, Kazuhiko
中科院分区：
文献类型：
--
作者：
Isomoto, Hajime;Nanashima, Atsushi;Nakao, Kazuhiko
目的：光动力诊断（PDD）是一种基于癌细胞基本生物学特征的成像技术。五氨基乙酰丙酸（ALA）是光敏原卟啉IX（PpIX）的前体，已得到应用。事实上，ALA 介导的 PDD 为某些肿瘤提供了良好的可视化效果。然而，PDD治疗胃肠道癌症的临床应用研究还很少。本研究旨在探讨ALA介导的PDD用于上消化道肿瘤导航的可行性。材料和方法：使用新开发的配备蓝色激光激发的内窥镜，对23例上消化道肿瘤患者的27个病灶（包括2例Barrett粘膜内癌）进行ALA介导的PDD。 PDD 前 3 小时口服 ALA 溶液。所有腺癌均属于临床I期，并通过内镜粘膜下剥离术和/或腹腔镜手术切除肿瘤。根据病例的临床病理特征评估红色荧光信号和强度。结果：基于激光的内窥镜检查可以在 27 个病变中的 23 个中检测到红色荧光导航（PDD 阳性）的上消化道肿瘤。除一种肠型肿瘤外，所有组织病理学均呈显着 PDD 阳性，而每种印戒细胞癌均为 PDD 阴性。 PDD阳性和阴性肿瘤之间的肿瘤大小存在显着差异。升高的病灶发出明显更强烈的荧光。结论：ALA 介导的 PDD 荧光导航提供了对上消化道肿瘤的充分检测，特别是肠型肿瘤。因此，使用配备蓝色激光的内窥镜的 ALA-PDD 提供了一种有前途的诊断工具。 (c) 2015 Elsevier B.V. 保留所有权利。
Objective: Photodynamic diagnosis (PDD) is an imaging technology that is based on the fundamental biological features of cancer cells. Five-aminolevulinic acid (ALA), a precursor of photosensitizing protoporphyrin IX (PpIX) has been applied. In fact, ALA-mediated PDD provides good visualization for certain tumors. However, there have been few studies on clinical application of PDD for gastrointestinal (GI) cancers. This study was aimed to investigate the feasibility of ALA-mediated PDD for navigation of upper GI tumors.Materials and methods: Using a newly developed endoscope equipped with a blue laser light excitation, ALA-mediated PDD was conducted in 27 lesions from 23 patients with upper GI tumors including 2 Barrett's intramucosal cancers. ALA solution was given orally 3 h before PDD. All the adenocarcinomas came under clinical stage I, and the tumors were resected endoscopic submucosal dissection and/or laparoscopic surgery. Red fluorescence signal and intensity was assessed as for clinicopathological features of the cases.Results: The laser-based endoscopy could detect upper GI tumors as red fluorescent navigation (PDD-positive) in 23 of the 27 lesions. All but one intestinal typed tumors in histopathology were significantly PDD-positive, whereas each signet ring cell carcinoma was PDD-negative. There was a significant difference in tumor size between the PDD-positive and -negative tumors. The elevated lesions emitted significantly more intense fluorescence.Conclusions: Fluorescence navigation by ALA-mediated PDD provided sufficient detection of upper GI tumors in particular for the intestinal typed tumors. Thus, ALA-PDD using the blue laser-equipped endoscope offers a promising diagnostic tool. (c) 2015 Elsevier B.V. All rights reserved.