Hillemanns Peter, Reiff Jessica, Stepp Herbert, Soergel Philipp
Department of Obstetrics and Gynecology, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
Lasers Med Sci. 2007 Sep;22(3):131-5. doi: 10.1007/s10103-006-0428-4. Epub 2007 Jan 9.
The concept of intraoperative in vivo diagnosis and selective resection of infiltrated lymph nodes in ovarian cancer has not been evaluated despite the increased morbidity associated with pelvic and paraaortic lymph node dissection and its questionable therapeutic value. Fluorescence photodetection is based on the application of a photosensitizer relatively selective for malignant tissue, which after light activation of appropriate wavelength, shows fluorescence. Six hours after oral application of 10 mg/kg body weight 5-aminolevulinic acid, the abdominal cavity of a patient with suspicion of recurrent ovarian cancer was inspected using a laparoscope and blue light at 380-440 nm. Spectral measurements at a wavelength of 635 nm, multiple peritoneal biopsies, and lymph node excisions were performed. White light inspection and porphyrin fluorescence photodetection revealed no intraperitoneal metastases and multiple biopsies were negative. Fluorescence-positive lymph nodes were visible only in the left common iliac region and a specific porphyrin fluorescence peak could be detected. In contrary, no increased porphyrin fluorescence of intraperitoneal tissues or skin was seen. Fluorescence microscopy showed the characteristic red fluorescence in the infiltrated parts of the lymph node tissue by the papillary ovarian cancer. Histology of the other sites was negative. No systemic or cutaneous side effects were recorded. This data is a proof of the concept that porphyrin fluorescence-guided lymph node metastasis detection is possible in ovarian cancer and should stimulate further research in this field.
尽管盆腔和腹主动脉旁淋巴结清扫术的发病率增加且其治疗价值存疑，但卵巢癌术中活体诊断和选择性切除浸润淋巴结的概念尚未得到评估。荧光光检测基于对恶性组织具有相对选择性的光敏剂的应用，该光敏剂在适当波长的光激活后会发出荧光。在口服10mg/kg体重的5-氨基乙酰丙酸6小时后，使用腹腔镜和380-440nm的蓝光对一名疑似复发性卵巢癌患者的腹腔进行检查。进行了635nm波长的光谱测量、多次腹膜活检和淋巴结切除。白光检查和卟啉荧光光检测未发现腹膜内转移，多次活检均为阴性。仅在左髂总区域可见荧光阳性淋巴结，并且可以检测到特定的卟啉荧光峰。相反，未观察到腹膜内组织或皮肤的卟啉荧光增加。荧光显微镜检查显示，卵巢乳头状癌浸润的淋巴结组织部分呈现特征性红色荧光。其他部位的组织学检查为阴性。未记录到全身或皮肤副作用。这些数据证明了在卵巢癌中进行卟啉荧光引导的淋巴结转移检测是可行的这一概念，应该会刺激该领域的进一步研究。
