Löning Martin C, Diddens Heyke C, Holl-Ulrich Konstanze, Löning Uta, Küpker Wolfgang, Diedrich Klaus, Hüttmann Gereon
Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
Lasers Surg Med. 2006 Jun;38(5):549-54. doi: 10.1002/lsm.20302.
Application of 5-aminolevulinic acid (ALA) for fluorescence-guided second-look laparoscopy has been shown to be a promising new procedure in the early diagnosis of ovarian carcinoma metastases. However, for assessing the reliability of this method, information on the microscopic distribution of protoporphyrin IX (PP IX) in the tissue is needed. Additionally, the selectivity of PP IX uptake is essential for a potential photodynamic therapy (PDT) of ovarian cancer metastases.
STUDY DESIGN/MATERIALS AND METHODS: Thirty-six patients with epithelial ovarian cancer and two patients suffering from fallopian tube carcinoma underwent a laparoscopic second-look procedure 5 hours after the application of ALA. In 17 patients 36 fluorescence-guided biopsies were taken from fluorescing and non-fluorescing tissues for further evaluation. Fluorescence microscopy and digital image processing were utilized to determine the presence of PP IX fluorescence.
A specificity of 88% and a sensitivity of 100% with a negative predictive value of 100% and a positive predictive value of 91% were calculated for PP IX fluorescence on a microscopic level as marker for ovarian cancer metastases.
On a microscopic scale, ALA-induced PP IX fluorescence is confined to ovarian cancer tumor tissue sparing stromal tissues.
5-氨基酮戊酸（ALA）在荧光引导二次腹腔镜检查中的应用已被证明是早期诊断卵巢癌转移的一种有前景的新方法。然而，为了评估该方法的可靠性，需要了解组织中原卟啉IX（PP IX）的微观分布信息。此外，PP IX摄取的选择性对于卵巢癌转移的潜在光动力疗法（PDT）至关重要。
研究设计/材料与方法：36例上皮性卵巢癌患者和2例输卵管癌患者在应用ALA后5小时接受了腹腔镜二次检查。在17例患者中，从荧光和非荧光组织中采集了36份荧光引导活检样本进行进一步评估。利用荧光显微镜和数字图像处理来确定PP IX荧光的存在。
在微观水平上，以PP IX荧光作为卵巢癌转移的标志物，计算出其特异性为88%，敏感性为100%，阴性预测值为100%，阳性预测值为91%。
在微观尺度上，ALA诱导的PP IX荧光局限于卵巢癌肿瘤组织，而基质组织未受影响。
