Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan.
Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan.
Gastric Cancer. 2020 Jul;23(4):725-733. doi: 10.1007/s10120-020-01044-w. Epub 2020 Feb 11.
5-aminolevulinic acid (5-ALA) has been utilized for cancer diagnosis as a fluorescence probe. We have reported the feasibility of 5-ALA-induced protoporphyrin IX (PpIX) fluorescence for detecting lymph node (LN) metastasis in gastrointestinal malignancies. However, a major barrier to the fluorescence diagnosis has been that the evaluation has been highly dependent on the observers. In this study, we examined the validity of a developed device for automated detection without subjectivity.
Gastric cancer patients who received oral administration of 5-ALA (20 mg/kg) prior to surgery were enrolled. For a total of 323 LNs obtained from 64 patients, the diagnostic results of the device were compared to those of conventional histopathological examination based on hematoxylin-and-eosin-stained slides. The accuracy with the device was compared to that of stereoscopic detection with conventional fluorescence microscopy for 211 LNs from 42 patients. We used two types of image processing that we previously developed to eliminate autofluorescence of background tissues: differential and ratio methods.
For detection of metastasis in 323 LNs, the areas under the receiver operating characteristic curves with the differential method and ratio method were 0.921 and 0.909, respectively. The sensitivity, specificity, and accuracy with the differential method were 78.0%, 96.8%, and 94.4%; while those with the ratio method were 78.0%, 96.1%, and 93.8%, respectively. In 211 LN analysis, the diagnostic accuracy with the device was comparable to that of stereoscopic examination.
Our device for automated detection of LN metastasis using 5-ALA can be a useful tool for intraoperative diagnosis.
5-氨基酮戊酸（5-ALA）已被用作荧光探针用于癌症诊断。我们已经报道了使用 5-ALA 诱导原卟啉 IX（PpIX）荧光检测胃肠道恶性肿瘤淋巴结（LN）转移的可行性。然而，荧光诊断的一个主要障碍是评估高度依赖于观察者。在这项研究中，我们检查了一种开发的设备的有效性，该设备可以自动检测，没有主观性。
接受手术前口服 5-ALA（20mg/kg）的胃癌患者被纳入研究。对 64 名患者的 323 个 LN 进行了研究，将设备的诊断结果与基于苏木精-伊红染色切片的常规组织病理学检查结果进行了比较。我们使用了两种我们之前开发的图像处理方法来消除背景组织的自发荧光：差分法和比率法。
在 323 个 LN 中检测转移时，差分法和比率法的曲线下面积分别为 0.921 和 0.909。差分法的敏感性、特异性和准确性分别为 78.0%、96.8%和 94.4%；而比率法的敏感性、特异性和准确性分别为 78.0%、96.1%和 93.8%。在 211 个 LN 分析中，设备的诊断准确性与立体检查相当。
我们的 5-ALA 用于 LN 转移自动检测的设备可以成为术中诊断的有用工具。
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