High Sensitive Intra-operative Fluorescent Diagnosis for Extent and Metastasis of Malignant Tumors

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1. GI surgery (Dr. Adachi)1) Intraoperative Fluorescence DiagnosisThree early one advanced gastric cancer patients were diagnosed by 5-ALA photodynamic diagnosis (PDD). All main lesions were positive. Lymph nodes showing fluorescence were positive for metastasis.2) Lymph node micro metastasis in advanced cancersAmong 134 lymph nodes, 35 lymph nodes were positive for PDD. Only two lesion showed pathological metastasis. However, all the PDD positive lymph nodes were positive for CK19, which indicate micro-metastasis before the pathological metastasis become evident.2. Respiratory Surgery (Dr. Ishikawa)7 cases were studied by 5-ALA tneidiated PDD (4 bronchoscopy and 3 intraoperative). Intraoperative PDD was not useful because the lesion were not on the surface. Bronchoscopic PDD was useful in defining the lesion at the wall of the trachea, which was better than autofluorescence technique.3. Neurosurgery (Dr. Matsumura, Nose, Takano)PDD was performed in 31 cases. The positive fluorescence was obtained in 23 cases (74.2%). The negative fluorescence were seen in patients with either no Gd(+) lesion or patients under corticosteroid therapy. The PDD was useful in determining the border of the tumor which was not clear with naked eyes. The pathological specimen shoed also good correlation of fluorescence and cell density and MIB-1 index, which indicate the tumor speciflticity of this method.