Arens C, Reussner D, Woenkhaus J, Leunig A, Betz C S, Glanz H
Department of Otorhinolaryngology/Head and Neck Surgery, University Hospitals Giessen and Marburg, Feulgenstrasse 10, 35385, Giessen, Germany.
Eur Arch Otorhinolaryngol. 2007 Jun;264(6):621-6. doi: 10.1007/s00405-007-0251-y. Epub 2007 Feb 10.
Indirect fluorescence endoscopy of the larynx has proven to facilitate the detection and delineation of precancerous and cancerous lesion. The different methods are easy to handle and can be performed on an outpatient basis. Early diagnosis of laryngeal cancer and its precursor lesions is simplified. The aim of the present study is to compare indirect autofluorescence laryngoscopy to 5-ALA-induced PPIX fluorescence laryngoscopy. In a prospective study, 56 patients with suspected precancerous or cancerous lesions were primarily investigated by indirect autofluorescence laryngoscopy. In a second step 5-ALA-NaCl (0.6%) was topically applied to the larynx by inhalation, and indirect fluorescence laryngoscopy repeated 2 h after application. Autofluorescence as well as 5-ALA-induced fluorescence was induced by filtered light (375-440 nm) of a xenon short arc lamp and processed by a CCD camera system (D-light-AF System, Storz, Tuttlingen, Germany). White-light and fluorescence images were digitally recorded, immediately assessed for diagnosis and finally compared to pathohistological findings. Inconspicuous laryngeal mucosa presented a typical green fluorescence signal in autofluorescence endoscopy, which turned blue during 5-ALA-laryngoscopy. Precancerous and cancerous lesions displayed a loss of autofluorescence in autofluorescence endoscopy whereas increased protoporphyrin IX fluorescence could be observed in 5-ALA laryngoscopy. Both imaging techniques were suitable to distinguish benign from precancerous or cancerous lesions. In contrast PPIX fluorescence was easily recognized in scarred vocal folds. According to our results, both non-invasive fluorescence imaging techniques are useful in the early diagnosis of laryngeal cancer. Moreover autofluorescence can be used immediately without drug application and possible side effects. 5-ALA-induced fluorescence seems to be more suited for diagnostic examination of mucosal lesions in recurrent precancerous and cancerous lesions after surgery.
喉间接荧光内镜检查已被证明有助于癌前病变和癌性病变的检测与描绘。不同方法易于操作，可在门诊进行。喉癌及其前驱病变的早期诊断得以简化。本研究的目的是比较间接自发荧光喉镜检查与5-氨基乙酰丙酸诱导的原卟啉IX荧光喉镜检查。在一项前瞻性研究中，56例疑似癌前或癌性病变的患者首先接受间接自发荧光喉镜检查。第二步，通过吸入将5-氨基乙酰丙酸钠（0.6%）局部应用于喉部，并在应用后2小时重复进行间接荧光喉镜检查。自发荧光以及5-氨基乙酰丙酸诱导的荧光由氙短弧灯的滤光（375 - 440 nm）光激发，并由电荷耦合器件相机系统（D-light-AF系统，德国图特林根的史托斯公司）处理。白光和荧光图像进行数字记录，立即进行诊断评估，最后与病理组织学结果进行比较。在自发荧光内镜检查中，不明显的喉黏膜呈现典型的绿色荧光信号，而在5-氨基乙酰丙酸喉镜检查期间变为蓝色。癌前和癌性病变在自发荧光内镜检查中显示出自发荧光丧失，而在5-氨基乙酰丙酸喉镜检查中可观察到原卟啉IX荧光增加。两种成像技术都适用于区分良性病变与癌前或癌性病变。相比之下，在瘢痕化的声带中很容易识别原卟啉IX荧光。根据我们的结果，两种非侵入性荧光成像技术都有助于喉癌的早期诊断。此外，自发荧光无需应用药物及可能的副作用即可立即使用。5-氨基乙酰丙酸诱导的荧光似乎更适合于手术后复发性癌前和癌性病变中黏膜病变的诊断检查。
