Kriegmair M, Zaak D, Knuechel R, Baumgartner R, Hofstetter A
Institute of Pathology, Clinic Ebersberg, Germany.
Semin Laparosc Surg. 1999 Jun;6(2):100-3. doi: 10.1053/SLAS00600100.
The use of a photodynamic fluorescence marker for diagnosis of tumors is an intriguing concept to improve thoroughness of surgical tumor resection. Complete surgical resection of multifocal bladder tumors and flat lesions as carcinoma in situ is known to be difficult, and thus a source of recurrencies. We report on the recent experience with the intravesical application of the photosensitizer prodrug 5-aminolevulinic acid (5-ALA), which is a nontoxic physiological heme substrate. Initial results from fluorescence diagnosis using krypton laser light and recent results with a modified incoherent light source constantly showed a 25% increase in urothelial tumor detection compared with white light endoscopy. Because of the high sensitivity, the number of biopsies could be decreased constantly compared with routine random biopsies taken under white light endoscopy. The results show about 25% to 30% of cases with fluorescent lesions, which are histologically benign. 5-ALA is a promising tool for diagnosis of bladder cancer. The outcome of the initial study of 5-ALA in urology in Germany is positive and is continued by prospective multicenter clinical studies to prove the hypothesis of reduction of tumor recurrence with this method. 5-ALA-based fluorescence endoscopy is strongly recommended for further clinical testing.
使用光动力荧光标记物诊断肿瘤是一个引人关注的概念，旨在提高手术肿瘤切除的彻底性。众所周知，完全手术切除多灶性膀胱肿瘤和平坦病变（如原位癌）很困难，因此是复发的一个根源。我们报告了膀胱内应用光敏前体药物5-氨基酮戊酸（5-ALA）的近期经验，5-ALA是一种无毒的生理性血红素底物。使用氪激光进行荧光诊断的初步结果以及使用改良非相干光源的近期结果持续显示，与白光内镜检查相比，尿路上皮肿瘤检测率提高了25%。由于灵敏度高，与白光内镜检查下进行的常规随机活检相比，活检次数可不断减少。结果显示，约25%至30%的病例有荧光病变，组织学上为良性。5-ALA是诊断膀胱癌的一种有前景的工具。德国5-ALA在泌尿外科的初步研究结果是阳性的，目前正在进行前瞻性多中心临床研究以证实该方法可降低肿瘤复发的假设。强烈建议基于5-ALA的荧光内镜检查进行进一步的临床试验。
