An Examination of the Usefulness of Photodynamic Diagnoses Using 5-Aminolevulinic Acid and an Autofluorescence Imaging System of Malignant Pleural Diseases

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  • 5ALAと自家蛍光観察システムを用いた胸膜悪性病変に対する光学的診断法の有用性の検討

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Abstract

<p>Introduction. We developed a new method for diagnosing malignant lesions of the pleura using 5-aminolevulinic acid (5-ALA) and an autofluorescence imaging system. 5-ALA is metabolized to protoporphyrin IX, which is a precursor of heme and remains in malignant cells, exhibiting red fluorescence at about 630 nm. After the oral administration of 5-ALA (4 hours before, 20 mg/kg), pleural malignant lesions were observed using an autofluorescence imaging system under thoracoscopy. Materials and Methods. From January 2017 to April 2019, we performed this procedure for a total of 130 patients: 82 cases of lung cancer suspected of pleural invasion, 32 cases of metastatic lung tumor, 7 cases of malignant pleural mesothelioma and 9 cases of intrathoracic benign disease. This study was a prospective study. Results. 1) In many malignant lesions including pleural infiltration, red fluorescence was recognized in contrast to the green autofluorescence exhibited by normal tissues. For malignant lesions located near the pleura, the significance of marking the tumor site at the time of a biopsy was also found. 2) The diagnosis of lung cancer pleural invasion was 81.0%, specificity 62.5%, positive predictive value 52.3% and negative predictive value 87.5% for pl0 or pl1 (pl1 or pl2) cases for pl1 to pl2 cases. However, for adenocarcinoma only, the sensitivity was 93.9%, specificity 74.3%, positive predictive value 60.8% and negative predictive value 96.2%. Of the cases in which fluorescence observation was possible even with pl0, 88.9% were diagnosed as preoperative PL1. Thease cases were pl0 pathologically, but the tumor was in contact with the pleura. 3) Pleural disseminated lesions were found in 6 cases, but in 2 cases, the diagnosis was difficult by white-light imaging but possible by our new method. Conclusion. If the tumor was in contact with the pleura and had invaded or was suspected of having pleural invasion, localization of the lesion could be made. This approach may facilitate the diagnosis of pleural dissemination, which can be difficult to detect.</p>

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