title: Staging laparoscopy using ALA-mediated photodynamic diagnosis improves the detection of peritoneal metastases in advanced gastric cancer.
abstract: BACKGROUND
  This study evaluated the usefulness of photodynamic diagnosis (PDD) using oral 5-aminolevulinic acid (ALA) for the detection of peritoneal metastases in advanced gastric cancer.
  
  
  METHODS
  First, the numbers of peritoneal metastatic nodules that were visible under conventional white light (WL) and ALA-induced fluorescence (ALA-F) were quantified in a mouse model of peritoneal metastasis to compare the tumor detection rate. Next, staging laparoscopy (SL) using ALA-PDD was performed in 13 advanced gastric cancer patients with serosa-invading tumors, and the detection sensitivity of ALA-PDD was compared to the observations using WL.
  
  
  RESULTS
  The tumor detection rate using ALA-F was significantly higher than the detection rate using WL (72% vs. 39%, respectively, P < 0.0001). Peritoneal metastases were detected in five patients using SL with ALA-PDD, and liver metastases were detected in one patient. These metastases were confirmed using histological examination. Three metastatic lesions that were invisible under WL were detected under ALA-F.
  
  
  CONCLUSIONS
  This study demonstrated that SL with ALA-PDD improved the detection sensitivity for peritoneal metastases. ALA-PDD may be an important technique for the preoperative staging of advanced gastric cancer, and ALA-PDD will provide useful information for the selection of therapeutic modality.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. kisi-ke@mc.pref.osaka.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kishi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Masahiro
authors.initials: M
authors.lastname: Inoue
authors.forename: Isao
authors.initials: I
authors.lastname: Miyashiro
authors.forename: Masaaki
authors.initials: M
authors.lastname: Motoori
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Shingai
authors.forename: Kunihito
authors.initials: K
authors.lastname: Gotoh
authors.forename: Hidenori
authors.initials: H
authors.lastname: Takahashi
authors.forename: Shingo
authors.initials: S
authors.lastname: Noura
authors.forename: Terumasa
authors.initials: T
authors.lastname: Yamada
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohue
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid; D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D005453:Fluorescence; D006801:Humans; D010535:Laparoscopy; D008027:Light; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000556:secondary; D017319:Photosensitizing Agents; D012704:Serous Membrane / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology*
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid