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Fluorescence Detection of Malignant Liver Tumors using 5-Aminolevulinic Acid-Mediated Photodynamic Diagnosis: Principles, Technique, and Clinical Experience

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Abstract

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.

Objective

Methods

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.

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Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

PDD:

Photodynamic diagnosis

5-ALA:

5-Aminolevulinic acid

HCC:

Hepatocellular carcinoma

CRCLM:

Liver metastasis from colorectal cancer

PBG:

Porphobilinogen

PBG-D:

Porphobilinogen deaminase

PpIX:

Protoporphyrin IX

FC:

Ferrochelatase

IPN-B:

Intraductal papillary neoplasms of the bile duct

TACE:

Transcatheter arterial chemoembolization

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Disclosure

Drs. Y. Inoue, M. Hayashi, R. Tanaka, K. Komeda, F. Hirokawa, and K. Uchiyama have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 daigaku-machi, Takatsuki, Osaka, 569-8686, Japan

    Yoshihiro Inoue, Ryo Tanaka, Koji Komeda, Fumitoshi Hirokawa, Michihiro Hayashi & Kazuhisa Uchiyama

Authors
  1. Yoshihiro Inoue
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  2. Ryo Tanaka
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  3. Koji Komeda
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  4. Fumitoshi Hirokawa
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  5. Michihiro Hayashi
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  6. Kazuhisa Uchiyama
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Correspondence to Yoshihiro Inoue.

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Inoue, Y., Tanaka, R., Komeda, K. et al. Fluorescence Detection of Malignant Liver Tumors using 5-Aminolevulinic Acid-Mediated Photodynamic Diagnosis: Principles, Technique, and Clinical Experience. World J Surg 38, 1786–1794 (2014). https://doi.org/10.1007/s00268-014-2463-9

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  • DOI: https://doi.org/10.1007/s00268-014-2463-9

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