Fluorescence detection of pleural malignancies using 5-aminolaevulinic acid.
OBJECTIVE
Although the use of video-assisted thoracoscopy has improved the diagnostic accuracy in patients presenting with pleural diseases, not all biopsies performed are conclusive and staging of the disease is not always optimal. Fluorescence diagnosis (FD) with 5-aminolaevulinic acid (5-ALA) has been used in the diagnostic workup for various malignancies. The impact of 5-ALA-mediated FD on diagnosis and staging during video-assisted thoracoscopy was examined.


METHODS
Prospective, single-center study.


METHODS
National cancer center.


METHODS
Twenty-six patients with nonconclusive pleural effusions who were scheduled for video-assisted thoracoscopy.


METHODS
Eligible patients were administered 1,500 to 2,500 mg po of 5-ALA before video-assisted thoracoscopy. After conventional inspection with white light, fluorescence inspection of the pleural cavity was performed (D-LIGHT Auto Fluorescent System; Karl Storz; Tuttlingen, Germany). Biopsy specimens of both normal and abnormal sites, as determined from white light and FD inspection, were obtained for histologic examination.


RESULTS
One patient was ineligible, and two patients were not evaluable because of equipment failure. One postoperative death occurred due to preexisting myocardial disease. In another patient, an empyema developed; in another patient, a postoperative infection of the lung developed. Other toxicities were minimal. A definitive diagnosis was obtained in 24 of 25 cases, with malignant mesothelioma in 15 cases, other malignancies in 5 cases, one infection, and three benign diseases. Upstaging occurred in four patients (unsuspected tumor deposits) due to FD examination. In 23 patients, a total of 111 biopsy specimens could be analyzed. When correct findings of white light and FD were compared, FD had an additional value in 21 of 111 biopsies, compared to white light with 16 of 111 biopsies.


CONCLUSIONS
FD using 5-ALA in the pleural cavity is feasible with limited side effects when used in addition to white light inspection. It improved visualization of abnormal lesions and led to upstaging in 4 of 15 mesothelioma patients.
Department of Thoracic Oncology, Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands. p.baas@nki.nl
Paul
P
Baas
Martijn
M
Triesscheijn
Sjaak
S
Burgers
Renée
R
van Pel
Fiona
F
Stewart
Maurice
M
Aalders
D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000378:metabolism; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis; D008875:Middle Aged; D017319:Photosensitizing Agents / Q000378:metabolism; D010997:Pleural Neoplasms / Q000175:diagnosis*; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013906:Thoracoscopy
D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid