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Detection of Metastatic Lymph Nodes Using 5-Aminolevulinic Acid in Patients with Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Precise diagnosis of lymph node metastases is essential to select therapeutic strategy for patients with gastric cancer, and rapid intraoperative diagnosis is useful for performing less invasive surgery. In this study, we focused on a known photosensitizer, 5-aminolevulinic acid (5-ALA), and examined the feasibility of 5-ALA-induced protoporphyrin IX (PpIX) fluorescence to detect metastatic foci in excised lymph nodes of patients with gastric cancer.

Methods

A total of 144 lymph nodes obtained from 14 gastric cancer patients were examined. The patients were administered 5-ALA orally before surgery. Excised lymph nodes were cut in half and observed by fluorescence microscopy. The diagnostic results were compared to those of the routine histopathological examination.

Results

Observed red fluorescence of PpIX was identical to the metastatic focus, with 84 % accuracy. Twelve non-metastatic lymph nodes showed unexpected PpIX accumulation to lymphoid follicles, but these could be discriminated based on their characteristic fluorescence patterns. With incorporation of this morphological consideration, this method demonstrated good diagnostic power with 92.4 % accuracy. On the quantitative analysis using the signal intensity ratio of red to the sum of red, green, and blue (R/(R + G + B) ratio) as an index corresponding to red fluorescence of PpIX, metastatic lymph nodes showed significantly higher value than non-metastatic lymph nodes (p < 0.0001). The area under the curve was calculated as 0.832 throughout Receiver operating characteristic analysis.

Conclusions

Our results demonstrated that 5-ALA-induced fluorescence diagnosis is a simple and safe method and is a potential candidate for a novel rapid intraoperative diagnostic method applicable to clinical practice.

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Acknowledgment

The authors thank Dr. Shin-ichi Miyatake of Osaka Medical College for his helpful advice. This work was partly supported by a project of the Japan Science and Technology Agency (JST), Japan.

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Authors and Affiliations

  1. Department of Pathology and Cell Regulation, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Noriaki Koizumi MD, Yoshinori Harada MD, PhD, Kenichi Harada MD, Masatomo Beika MD, Yoshihisa Yamaoka PhD, Ping Dai PhD & Tetsuro Takamatsu MD, PhD

  2. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Noriaki Koizumi MD, Yasutoshi Murayama MD, PhD, Kenichi Harada MD, Masatomo Beika MD, Shuhei Komatsu MD, PhD, Takeshi Kubota MD, PhD, Daisuke Ichikawa MD, PhD, Kazuma Okamoto MD, PhD & Eigo Otsuji MD, PhD

  3. Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Akio Yanagisawa MD, PhD

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  1. Noriaki Koizumi MD
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Correspondence to Tetsuro Takamatsu MD, PhD.

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Koizumi, N., Harada, Y., Murayama, Y. et al. Detection of Metastatic Lymph Nodes Using 5-Aminolevulinic Acid in Patients with Gastric Cancer. Ann Surg Oncol 20, 3541–3548 (2013). https://doi.org/10.1245/s10434-013-3017-3

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