title: Fluorescence hysteroscopy using 5-aminolevulinic: a descriptive study.
abstract: OBJECTIVE
  To assess the feasibility of fluorescence hysteroscopy following topical ALA application and to describe the optical appearance of normal and neoplastic endometrium.
  
  
  METHODS
  Fifty-four patients scheduled for routine hysteroscopy and D&C were assigned to the study group using topically applied ALA. Two milliliters of a 2% 5-ALA-solution at pH = 4.0 (ASAT AG/Zug, Switzerland) was administrated into the uterine cavity 4 hours before fluorescence hysteroscopy, using a STORZ-D-Light (Tuttlingen, Germany) system. Hysteroscopic findings were compared to the histological diagnosis of hematoxylin & eosin (H&E) stained sections. In the study group, 60 histological specimens were taken (47 materials of curettage and 13 targeted biopsies). The percentage of fluorescence positive patients was calculated.
  
  
  RESULTS
  The rate of fluorescent endometrial samples was low in atrophic endometrium 1/16 (6.2%). Endometrial carcinoma were diagnosed in two patients. Both cases exhibited selective and intense PpIX-mediated red fluorescence. Fluorescence hysteroscopy could not differentiate between hyperplastic areas with or without atypia. Minimal uterine cramps or discomfort following ALA instillation were complained by 30 (56%) patients, no pain was indicated by 24 patients (44%).
  
  
  CONCLUSIONS
  Fluorescence hysteroscopy following intrauterine application of ALA is feasible. Cancerous, hyperplastic, and secretory endometrial tissue showed high red fluorescence.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Zurich, Zürich 8091, Switzerland. pius.wyss@fhk.usz.ch
authors.forename: Pius
authors.initials: P
authors.lastname: Wyss
authors.forename: Andrea
authors.initials: A
authors.lastname: Degen
authors.forename: Rosmarie
authors.initials: R
authors.lastname: Caduff
authors.forename: Rene
authors.initials: R
authors.lastname: Hornung
authors.forename: Urs
authors.initials: U
authors.lastname: Haller
authors.forename: Mathias
authors.initials: M
authors.lastname: Fehr
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000008:administration & dosage; D004714:Endometrial Hyperplasia / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D005453:Fluorescence; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D008875:Middle Aged; D017319:Photosensitizing Agents / Q000008:administration & dosage; D010865:Pilot Projects
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid