Saito Takahiro, Ebihara Yuma, Li Liming, Shirosaki Tomoya, Iijima Hiroaki, Tanaka Kimitaka, Nakanishi Yoshitsugu, Asano Toshimichi, Noji Takehiro, Kurashima Yo, Murakami Soichi, Nakamura Toru, Tsuchikawa Takahiro, Okamura Keisuke, Shichinohe Toshiaki, Hirano Satoshi
Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan.
Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan.
Photodiagnosis Photodyn Ther. 2021 Mar;33:102157. doi: 10.1016/j.pdpdt.2020.102157. Epub 2020 Dec 25.
Diagnosing peritoneal dissemination is essential for selecting the appropriate therapeutic strategy for patients with pancreatic cancer. Intraoperative laparoscopic diagnosis enables the selection of less invasive surgical strategies. Photodynamic diagnosis using 5-aminolevulinic acid may improve gastrointestinal cancer diagnostic accuracy, although weak fluorescence is not easily detected. Here we aimed to improve this sensitivity using laparoscopic spectrophotometry.
Photodynamic diagnosis was performed using serial dilutions of protoporphyrin IX, and its detectability using laparoscopic spectrophotometry was compared with that using naked-eye observation. Five-aminolevulinic acid-photodynamic diagnosis was performed for pancreatic cancer cell lines, and a murine peritoneal disseminated nodule model was established. We compared laparoscopic spectrophotometry and naked-eye observation results using white and fluorescent lights and compared them to routine histopathological examination results. Photodynamic diagnoses were made in 2017 and 2018 in eight patients with pancreatic cancer.
Weaker fluorescence of the diluted protoporphyrin IX samples was better detected with spectrophotometry than with naked-eye observation. Moreover, a spectrograph of protoporphyrin IX in multiple cell lines was detected by spectrophotometry. In the murine model, the detection rates were 62 %, 78 %, and 90 % for naked-eye observation with white light, fluorescent light, and spectrophotometry, respectively. Comparisons of fluorescent light-negative peritonea with and without pathological metastases showed significantly higher spectrophotometric intensities in the former (P < 0.010). In clinical studies, three fluorescent light-negative spectrophotometry-positive pathologically metastatic lesions were observed.
Laparoscopic spectrophotometry in the murine model and extraperitoneally photodynamic diagnoses using spectrophotometry in clinical practice are sensitive photodynamic diagnostic techniques.
诊断腹膜播散对于为胰腺癌患者选择合适的治疗策略至关重要。术中腹腔镜诊断有助于选择侵入性较小的手术策略。使用5-氨基酮戊酸的光动力诊断可能会提高胃肠道癌的诊断准确性，尽管弱荧光不易被检测到。在此，我们旨在通过腹腔镜分光光度法提高这种敏感性。
使用原卟啉IX的系列稀释液进行光动力诊断，并将腹腔镜分光光度法的可检测性与肉眼观察的可检测性进行比较。对胰腺癌细胞系进行5-氨基酮戊酸光动力诊断，并建立小鼠腹膜播散结节模型。我们比较了使用白光和荧光的腹腔镜分光光度法和肉眼观察结果，并将它们与常规组织病理学检查结果进行比较。在2017年和2018年对8例胰腺癌患者进行了光动力诊断。
分光光度法比肉眼观察能更好地检测稀释的原卟啉IX样品的较弱荧光。此外，通过分光光度法检测到多个细胞系中原卟啉IX的光谱图。在小鼠模型中，白光肉眼观察、荧光观察和分光光度法的检测率分别为62%、78%和90%。对有无病理转移的荧光阴性腹膜进行比较，前者的分光光度强度明显更高（P < ０.０１０）。在临床研究中，观察到3个荧光阴性、分光光度法阳性的病理转移病变。
小鼠模型中的腹腔镜分光光度法以及临床实践中使用分光光度法进行的腹膜外光动力诊断是敏感的光动力诊断技术。
