Department of Thoracic Surgery, PA Hertsen Moscow Research Institute of Oncology, Moscow, Russian Federation.
Eur J Cardiothorac Surg. 2012 Mar;41(3):649-52. doi: 10.1093/ejcts/ezr086. Epub 2011 Dec 1.
Conventional thoracoscopy, routinely performed in patients with pleural diseases, is not always conclusive in staging of pleural spread. Fluorescence diagnosis (FD) with 5-aminolaevulinic acid (5-ALA) has been used in the diagnostic purpose for various malignancies. The impact of fluorescence thoracoscopy on diagnosis and staging of pleural malignancies was examined.
A total of 23 patients with non-conclusive pleural effusions were enrolled in the prospective single-institution trial. Eligible patients were administered 25 mg/kg of 5-ALA ('Alasense', Niopik, Russian Federation) per os 3 h before video-assisted thoracoscopy. After conventional inspection with white light, thorough fluorescence investigation of the visceral and parietal pleura was performed (D-LIGHT Auto Fluorescent System, Karl Storz, Germany). Biopsy specimens of both normal and abnormal sites, as determined from white-light and FD inspection, were obtained for histological examination.
There was no morbidity or mortality due to the procedure. A definitive diagnosis was obtained in all cases: malignant mesothelioma in 13 cases, other malignancies (pleural metastases) in 8 cases and non-specific inflammation in 3 patients. A total of 118 biopsy specimens were available for histological examination. In 20 patients, all pleural deposits (n = 60) detected by white-light thoracoscopy had bright red fluorescence during FD and were proved to be malignant. Upstaging occurred in 12 patients (57.2%) (unsuspected 21 tumour deposits) due to FD examination. Micrometastases of macroscopically normal pleura were detected, only by FD, in one patient. Comparing the results of histological examination of specimens detected by conventional thoracoscopy with that by fluorescence thoracoscopy, we obtained 82 true positive, 10 false-negative, 23 true negative, 3 false-positive results with a specificity of 88.4%, sensitivity of 89.1% and diagnostic accuracy of 88.9%.
FD using 5-ALA in the pleural cavity is a feasible diagnostic tool when used in addition to white-light thoracoscopy. It improves visualization of additional lesions or even micrometastases in patients with pleural malignancy.
常规胸腔镜检查常用于胸膜疾病患者，但在胸膜扩散分期方面并不总是具有结论性。5-氨基酮戊酸（5-ALA）荧光诊断已用于各种恶性肿瘤的诊断目的。本研究旨在检查荧光胸腔镜对胸膜恶性肿瘤的诊断和分期的影响。
前瞻性单中心试验共纳入 23 例胸腔积液不明确的患者。符合条件的患者在视频辅助胸腔镜检查前 3 小时口服 25mg/kg 5-ALA（'Alasense'，Niopik，俄罗斯联邦）。在白光常规检查后，对脏层和壁层胸膜进行彻底的荧光检查（D-LIGHT 自动荧光系统，Karl Storz，德国）。根据白光和 FD 检查确定的正常和异常部位均获得活检标本，用于组织学检查。
该操作无发病率或死亡率。所有病例均获得明确诊断：13 例恶性间皮瘤、8 例其他恶性肿瘤（胸膜转移）和 3 例非特异性炎症。共获得 118 个活检标本进行组织学检查。在 20 例患者中，白光胸腔镜检查发现的所有胸膜沉积物（n=60）在 FD 检查时均呈鲜红色荧光，证实为恶性。由于 FD 检查，12 例患者（57.2%）发生分期升级（未发现 21 个肿瘤沉积物）。仅通过 FD 检测到一个患者的宏观正常胸膜的微转移。将常规胸腔镜检查发现的标本的组织学检查结果与荧光胸腔镜检查的结果进行比较，我们获得了 82 个真阳性、10 个假阴性、23 个真阴性和 3 个假阳性结果，特异性为 88.4%，敏感性为 89.1%，诊断准确性为 88.9%。
在白光胸腔镜检查的基础上，使用 5-ALA 的 FD 是一种可行的诊断工具。它可以改善胸膜恶性肿瘤患者的额外病变甚至微转移的可视化。
