title: Fluorescence staining of human ovarian cancer tissue following application of 5-aminolevulinic acid: fluorescence microscopy studies.
abstract: OBJECTIVE
  Application of 5-aminolevulinic acid (ALA) for fluorescence-guided second-look laparoscopy has been shown to be a promising new procedure in the early diagnosis of ovarian carcinoma metastases. However, for assessing the reliability of this method, information on the microscopic distribution of protoporphyrin IX (PP IX) in the tissue is needed. Additionally, the selectivity of PP IX uptake is essential for a potential photodynamic therapy (PDT) of ovarian cancer metastases.
  
  
  METHODS
  Thirty-six patients with epithelial ovarian cancer and two patients suffering from fallopian tube carcinoma underwent a laparoscopic second-look procedure 5 hours after the application of ALA. In 17 patients 36 fluorescence-guided biopsies were taken from fluorescing and non-fluorescing tissues for further evaluation. Fluorescence microscopy and digital image processing were utilized to determine the presence of PP IX fluorescence.
  
  
  RESULTS
  A specificity of 88% and a sensitivity of 100% with a negative predictive value of 100% and a positive predictive value of 91% were calculated for PP IX fluorescence on a microscopic level as marker for ovarian cancer metastases.
  
  
  CONCLUSIONS
  On a microscopic scale, ALA-induced PP IX fluorescence is confined to ovarian cancer tumor tissue sparing stromal tissues.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany. loening@gmx.de
authors.forename: Martin C
authors.initials: MC
authors.lastname: Löning
authors.forename: Heyke C
authors.initials: HC
authors.lastname: Diddens
authors.forename: Konstanze
authors.initials: K
authors.lastname: Holl-Ulrich
authors.forename: Uta
authors.initials: U
authors.lastname: Löning
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Küpker
authors.forename: Klaus
authors.initials: K
authors.lastname: Diedrich
authors.forename: Gereon
authors.initials: G
authors.lastname: Hüttmann
mesh_terms: D000622:Aminolevulinic Acid / Q000494:pharmacology*; D014408:Biomarkers, Tumor / Q000378:metabolism; D001706:Biopsy; D005185:Fallopian Tube Neoplasms / Q000378:metabolism* / Q000473:pathology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008856:Microscopy, Fluorescence; D010051:Ovarian Neoplasms / Q000378:metabolism* / Q000473:pathology; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000494:pharmacology*; D011237:Predictive Value of Tests; D011524:Protoporphyrins / Q000378:metabolism*; D024162:Second-Look Surgery; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D017319:Photosensitizing Agents; D011524:Protoporphyrins; D000622:Aminolevulinic Acid; C028025:protoporphyrin IX