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

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),...

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Bibliographic Details
Published in:Annals of surgical oncology 2013-10, Vol.20 (11), p.3541-3548
Main Authors: Koizumi, Noriaki, Harada, Yoshinori, Murayama, Yasutoshi, Harada, Kenichi, Beika, Masatomo, Yamaoka, Yoshihisa, Dai, Ping, Komatsu, Shuhei, Kubota, Takeshi, Ichikawa, Daisuke, Okamoto, Kazuma, Yanagisawa, Akio, Otsuji, Eigo, Takamatsu, Tetsuro
Format: Article
Language:English
Subjects:
Aminolevulinic Acid
Fluorescence
Gastrointestinal Oncology
Humans
Lymph Nodes - drug effects
Lymph Nodes - pathology
Lymphatic Metastasis
Medicine
Medicine & Public Health
Neoplasm Staging
Oncology
Photosensitizing Agents
Prognosis
Protoporphyrins
ROC Curve
Stomach Neoplasms - diagnosis
Stomach Neoplasms - surgery
Surgery
Surgical Oncology
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Summary: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  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-013-3017-3