Isomoto Hajime, Nanashima Atsushi, Senoo Takemasa, Ogiwara Kumi, Hashisako Mikiko, Ohnita Ken, Yamaguchi Naoyuki, Kunizaki Masaki, Hidaka Shigekazu, Fukuda Hiroko, Ishii Hiroyuki, Matsushima Kayoko, Minami Hitomi, Akazawa Yuko, Takeshima Fuminao, Fukuoka Junya, Nagayasu Takeshi, Nakao Kazuhiko
Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
First Department of Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Photodiagnosis Photodyn Ther. 2015 Jun;12(2):201-8. doi: 10.1016/j.pdpdt.2015.03.006. Epub 2015 Mar 31.
Photodynamic diagnosis (PDD) is an imaging technology that is based on the fundamental biological features of cancer cells. Five-aminolevulinic acid (ALA), a precursor of photosensitizing protoporphyrin IX (PpIX) has been applied. In fact, ALA-mediated PDD provides good visualization for certain tumors. However, there have been few studies on clinical application of PDD for gastrointestinal (GI) cancers. This study was aimed to investigate the feasibility of ALA-mediated PDD for navigation of upper GI tumors.
Using a newly developed endoscope equipped with a blue laser light excitation, ALA-mediated PDD was conducted in 27 lesions from 23 patients with upper GI tumors including 2 Barrett's intramucosal cancers. ALA solution was given orally 3h before PDD. All the adenocarcinomas came under clinical stage I, and the tumors were resected endoscopic submucosal dissection and/or laparoscopic surgery. Red fluorescence signal and intensity was assessed as for clinicopathological features of the cases.
The laser-based endoscopy could detect upper GI tumors as red fluorescent navigation (PDD-positive) in 23 of the 27 lesions. All but one intestinal typed tumors in histopathology were significantly PDD-positive, whereas each signet ring cell carcinoma was PDD-negative. There was a significant difference in tumor size between the PDD-positive and -negative tumors. The elevated lesions emitted significantly more intense fluorescence.
Fluorescence navigation by ALA-mediated PDD provided sufficient detection of upper GI tumors in particular for the intestinal typed tumors. Thus, ALA-PDD using the blue laser-equipped endoscope offers a promising diagnostic tool.
光动力诊断（PDD）是一种基于癌细胞基本生物学特征的成像技术。已应用了作为光敏原卟啉IX（PpIX）前体的5-氨基乙酰丙酸（ALA）。实际上，ALA介导的PDD能为某些肿瘤提供良好的可视化效果。然而，关于PDD在胃肠道（GI）癌临床应用的研究较少。本研究旨在探讨ALA介导的PDD在上消化道肿瘤导航中的可行性。
使用新开发的配备蓝色激光激发装置的内窥镜，对23例上消化道肿瘤患者的27个病变进行ALA介导的PDD，其中包括2例巴雷特黏膜内癌。在PDD前3小时口服ALA溶液。所有腺癌均处于临床I期，肿瘤通过内镜黏膜下剥离术和/或腹腔镜手术切除。针对病例的临床病理特征评估红色荧光信号和强度。
基于激光的内窥镜检查可在27个病变中的23个检测到上消化道肿瘤呈现红色荧光导航（PDD阳性）。组织病理学中除1例肠型肿瘤外，所有肿瘤均显著PDD阳性，而各印戒细胞癌均为PDD阴性。PDD阳性和阴性肿瘤之间的肿瘤大小存在显著差异。隆起性病变发出的荧光强度明显更高。
ALA介导的PDD荧光导航对上消化道肿瘤尤其是肠型肿瘤提供了充分的检测。因此，使用配备蓝色激光的内窥镜进行ALA-PDD提供了一种有前景的诊断工具。
