Motoori Masaaki, Yano Masahiko, Tanaka Koji, Kishi Kentaro, Takahashi Hidenori, Inoue Masahiro, Saito Takuro, Sugimura Keijiro, Fujiwara Yoshiyuki, Ishikawa Osamu, Sakon Masato
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan.
Department of Biochemistry, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan.
Oncol Lett. 2015 Nov;10(5):3035-3039. doi: 10.3892/ol.2015.3685. Epub 2015 Sep 8.
Lymph node metastasis is the strongest prognostic factor in esophageal cancer patients who have undergone esophagectomy. The accurate diagnosis of lymph node metastasis is important, but the pre-operative diagnostic accuracy is poor. The intraoperative diagnosis based on histopathological examination of frozen tissue specimens is complicated and time-consuming. Therefore, the establishment of a simple and rapid intraoperative diagnostic method is essential. Exogenous application of 5-aminolevulinic acid (ALA) causes a selective accumulation of protoporphyrin IX, which is a fluorescent substrate, in cancer cells. The present study evaluated the feasibility of photodynamic diagnosis using ALA (ALA-PDD) for lymph node metastasis in esophageal cancer. A total of 292 lymph nodes were analyzed from 8 esophageal squamous cell cancer patients treated with esophagectomy. The patients were administered ALA orally prior to surgery. Excised lymph nodes were cut in half and examined by spectrometer. The diagnostic results of ALA-PDD were compared to those of the histopathological examination. Among the 292 lymph nodes, 19 nodes (6.5%) were histologically metastatic and 21 nodes (7.2%) were PDD-positive. The sensitivity and specificity of ALA-PDD were 84.2% (16/19) and 98.2% (268/273), respectively. The area of cancer nests of the PDD-negative lymph nodes was <2 mm. Metastatic lymph nodes, including cancer nests >4 mm, were correctly diagnosed by ALA-PDD. In conclusion, this study demonstrated that ALA-PDD of lymph node metastasis in patients with esophageal cancer is feasible. Further investigation would make this method a simple and rapid intraoperative diagnostic tool.
淋巴结转移是接受食管切除术的食管癌患者中最强的预后因素。准确诊断淋巴结转移很重要，但术前诊断准确性较差。基于冷冻组织标本组织病理学检查的术中诊断复杂且耗时。因此，建立一种简单快速的术中诊断方法至关重要。外源性应用5-氨基酮戊酸（ALA）可导致原卟啉IX（一种荧光底物）在癌细胞中选择性积聚。本研究评估了使用ALA进行光动力诊断（ALA-PDD）对食管癌淋巴结转移的可行性。对8例接受食管切除术的食管鳞状细胞癌患者的总共292个淋巴结进行了分析。患者在手术前口服ALA。将切除的淋巴结切成两半，用光谱仪检查。将ALA-PDD的诊断结果与组织病理学检查结果进行比较。在292个淋巴结中，19个（6.5%）在组织学上有转移，21个（7.2%）PDD呈阳性。ALA-PDD的敏感性和特异性分别为84.2%（16/19）和98.2%（268/273）。PDD阴性淋巴结的癌巢面积<2mm。包括癌巢>4mm的转移性淋巴结通过ALA-PDD被正确诊断。总之，本研究表明ALA-PDD用于食管癌患者淋巴结转移的诊断是可行的。进一步的研究将使该方法成为一种简单快速的术中诊断工具。
