Fluorescence detection of malignant liver tumors using 5-aminolevulinic acid-mediated photodynamic diagnosis: principles, technique, and clinical experience.
BACKGROUND
Photoactive drugs selectively accumulate in malignant tissue specimens and cause drug-induced fluorescence. Photodynamic diagnosis (PDD) and fluorescence can distinguish normal from malignant tissue.
From May 2012 to September 2013, a total of 70 patients underwent hepatic resections using 5-ALA-mediated PDD for liver tumors at our hospital.


RESULTS
5-ALA fluorescence was detected in all hepatocellular carcinoma cases with serosa invasion. In liver metastasis from colorectal cancer cases with serosa invasion, 18 patients (85.7 %) were detected, and three patients (14.2 %) whose tumors showed complete response to neoadjuvant chemotherapy showed no fluorescence. Both superficial and deep malignant liver tumors were detected with 92.5 % sensitivity. Using 5-ALA-mediated PDD, tumors remaining at the cut surface and postoperative bile leakage were less frequent than in our previous hepatic resections using conventional white-light observation. Moreover, all malignant liver tumors were completely removed with a clear microscopic margin using 5-ALA, with a significant difference in resection margin width between 5-ALA-mediated PDD (6.7 ± 6.9 mm) and white-light observation (9.2 ± 7.0 mm; p = 0.0083).


CONCLUSIONS
With the detection of malignant liver tumors, residual tumor and bile leakage at the cut surface of the remnant liver were improved by PDD with 5-ALA. This procedure may provide greater sensitivity than the conventional procedure. Furthermore, 5-ALA-mediated PDD can ensure histological clearance regardless of the resection margin and preserve as much liver parenchyma as possible in patients with impaired liver function.
Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 daigaku-machi, Takatsuki, Osaka, 569-8686, Japan, sur129@poh.osaka-med.ac.jp.
Yoshihiro
Y
Inoue
Ryo
R
Tanaka
Koji
K
Komeda
Fumitoshi
F
Hirokawa
Michihiro
M
Hayashi
Kazuhisa
K
Uchiyama
D000368:Aged; D000622:Aminolevulinic Acid / Q000378:metabolism; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000601:surgery; D003116:Color; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005453:Fluorescence; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D061646:Operative Time; D017319:Photosensitizing Agents / Q000378:metabolism; D011524:Protoporphyrins / Q000032:analysis
D017319:Photosensitizing Agents; D011524:Protoporphyrins; D000622:Aminolevulinic Acid; C028025:protoporphyrin IX