Fluorescence Detection of Malignant Liver Tumors using 5-Aminolevulinic Acid-Mediated Photodynamic Diagnosis: Principles, Technique, and Clinical Experience
Fluorescence Detection of Malignant Liver Tumors using 5-Aminolevulinic Acid-Mediated Photodynamic Diagnosis: Principles, Technique, and Clinical Experience
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DOI：
10.1007/s00268-014-2463-9
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发表时间：
2014-07-01
影响因子：
2.6
通讯作者：
Uchiyama, Kazuhisa
中科院分区：
文献类型：
--
作者：
Inoue, Yoshihiro;Tanaka, Ryo;Uchiyama, Kazuhisa
光活性药物选择性地在恶性组织标本中积累并引起药物诱导的荧光。光动力诊断（PDD）和荧光可以区分正常和恶性组织。2012年5月至2013年9月，我院共有70例肝脏肿瘤患者采用5- ala介导的PDD进行肝切除术。5-ALA荧光在所有浸润浆膜的肝细胞癌中检测到。在伴有浆膜浸润的结直肠癌肝转移病例中，检出18例（85.7%），新辅助化疗完全缓解的3例（14.2%）肿瘤无荧光。浅表和深部恶性肝肿瘤的检出率均为92.5%。使用5- ala介导的PDD，与我们之前使用传统白光观察的肝切除术相比，肿瘤残留在切口表面和术后胆漏的发生率较低。此外，5-ALA完全切除了所有肝脏恶性肿瘤，镜检边缘清晰，5-ALA介导的PDD （6.7 +/- a 6.9 mm）和白光观察（9.2 +/- a 7.0 mm, p = 0.0083）的切除边缘宽度有显著差异。随着肝恶性肿瘤的检出，5-ALA联合PDD可改善残肝切面残余肿瘤及胆漏。这种方法可能比传统方法提供更高的灵敏度。此外，5- ala介导的PDD可以在肝功能受损患者中确保组织学清除，无论切除边缘如何，并尽可能多地保留肝实质。
Photoactive drugs selectively accumulate in malignant tissue specimens and cause drug-induced fluorescence. Photodynamic diagnosis (PDD) and fluorescence can distinguish normal from malignant tissue.From May 2012 to September 2013, a total of 70 patients underwent hepatic resections using 5-ALA-mediated PDD for liver tumors at our hospital.5-ALA fluorescence was detected in all hepatocellular carcinoma cases with serosa invasion. In liver metastasis from colorectal cancer cases with serosa invasion, 18 patients (85.7 %) were detected, and three patients (14.2 %) whose tumors showed complete response to neoadjuvant chemotherapy showed no fluorescence. Both superficial and deep malignant liver tumors were detected with 92.5 % sensitivity. Using 5-ALA-mediated PDD, tumors remaining at the cut surface and postoperative bile leakage were less frequent than in our previous hepatic resections using conventional white-light observation. Moreover, all malignant liver tumors were completely removed with a clear microscopic margin using 5-ALA, with a significant difference in resection margin width between 5-ALA-mediated PDD (6.7 +/- A 6.9 mm) and white-light observation (9.2 +/- A 7.0 mm; p = 0.0083).With the detection of malignant liver tumors, residual tumor and bile leakage at the cut surface of the remnant liver were improved by PDD with 5-ALA. This procedure may provide greater sensitivity than the conventional procedure. Furthermore, 5-ALA-mediated PDD can ensure histological clearance regardless of the resection margin and preserve as much liver parenchyma as possible in patients with impaired liver function.