Abstract
Background: Fluorescence diagnosis (FD) using the photosensitiser 5-aminolaevulinic acid (ALA) was experimentally combined with conventional video assisted thoracic surgery (VATS) to improve tumour staging in advanced lung cancer with pleural tumour spread.
Methods: A disseminated pleural carcinosis affecting the entire pleural cavity was induced by inoculation of human adenocarcinoma cells in nude rats. After 5–7 weeks of tumour growth the animals were randomised into six groups with different photosensitisation parameters. Pleural lavage was performed either with 1.5% or 3.0% ALA solution. Photosensitisation times varied were 2, 4, or 6 hours. Conventional white light VATS was first performed to evaluate tumour growth in the pleural cavity. Fluorescence illumination of the light source, the D-light, was then used to examine the site for additional tumours which were previously invisible. The tumour fluorescence intensity was measured spectrometrically and compared with normal tissue.
Results: Compared with conventional white light VATS alone, thoracoscopic fluorescence diagnosis (TFD) detected up to 30% additional pleural malignant lesions. The highest diagnostic sensitivity was reached 6 hours after 3.0% ALA pleural lavage. Photosensitiser accumulation in the tumour, measured indirectly by spectrometry, was up to 11 times higher than in normal tissue.
Conclusions: TFD increases sensitivity of VATS for tumour staging. It may prevent unnecessary thoracotomies in cancer patients and facilitate surgical planning.
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Selected References
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- Boutin C., Frenay C., Astoul P. Diagnostic endoscopique du mésothéliome. Rev Mal Respir. 1999 Dec;16(6 Pt 2):1257–1262. [PubMed] [Google Scholar]
- Boutin C., Monnet I., Ruffie P., Astoul P. Mésothéliome malin: étude clinique et thérapeutique. Rev Mal Respir. 1999 Dec;16(6 Pt 2):1317–1326. [PubMed] [Google Scholar]
- Boutin C., Schlesser M., Frenay C., Astoul P. Malignant pleural mesothelioma. Eur Respir J. 1998 Oct;12(4):972–981. doi: 10.1183/09031936.98.12040972. [DOI] [PubMed] [Google Scholar]
- Champion J. K., McKernan J. B. Comparison of minimally invasive thoracoscopy versus open thoracotomy for staging lung cancer. Int Surg. 1996 Jul-Sep;81(3):235–236. [PubMed] [Google Scholar]
- Gahlen J., Prosst R. L., Pietschmann M., Rheinwald M., Haase T., Herfarth C. Spectrometry supports fluorescence staging laparoscopy after intraperitoneal aminolaevulinic acid lavage for gastrointestinal tumours. J Photochem Photobiol B. 1999 Sep-Oct;52(1-3):131–135. doi: 10.1016/s1011-1344(99)00119-0. [DOI] [PubMed] [Google Scholar]
- Gahlen J., Stern J., Laubach H. H., Pietschmann M., Herfarth C. Improving diagnostic staging laparoscopy using intraperitoneal lavage of delta-aminolevulinic acid (ALA) for laparoscopic fluorescence diagnosis. Surgery. 1999 Sep;126(3):469–473. [PubMed] [Google Scholar]
- Gahlen J., Stern J., Pressmar J., Böhm J., Holle R., Herfarth C. Local 5-aminolevulinic acid application for laser light-induced fluorescence diagnosis of early staged colon cancer in rats. Lasers Surg Med. 2000;26(3):302–307. doi: 10.1002/(sici)1096-9101(2000)26:3<302::aid-lsm8>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
- Gahlen Johannes, Prosst Ruediger L., Pietschmann Matthias, Haase Thomas, Rheinwald Markus, Skopp Gisela, Stern Josef, Herfarth Christian. Laparoscopic fluorescence diagnosis for intraabdominal fluorescence targeting of peritoneal carcinosis experimental studies. Ann Surg. 2002 Feb;235(2):252–260. doi: 10.1097/00000658-200202000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ho L., Sugarbaker D. J., Skarin A. T. Malignant pleural mesothelioma. Cancer Treat Res. 2001;105:327–373. doi: 10.1007/978-1-4615-1589-0_13. [DOI] [PubMed] [Google Scholar]
- Petrakis I., Katsamouris A., Drossitis I., Bouros D., Chalkiadakis G. Usefulness of thoracoscopic surgery in the diagnosis and management of thoracic diseases. J Cardiovasc Surg (Torino) 2000 Oct;41(5):767–771. [PubMed] [Google Scholar]
- Rau B., Hünerbein M., Barth C., Schlag P. M. Thorakoskopische Diagnostik und Therapie von Lungenmetastasen. Zentralbl Chir. 1998;123(10):1125–1128. [PubMed] [Google Scholar]
- Rau B., Hünerbein M., Below C., Schlag P. M. Video-assisted thoracic surgery. Staging and management of thoracic tumors. Surg Endosc. 1998 Feb;12(2):133–136. doi: 10.1007/s004649900613. [DOI] [PubMed] [Google Scholar]
- Rieger R., Wayand W. Videoassistierte Thorakoskopie zur Diagnose und Therapie intrathorakaler Erkrankungen. Zentralbl Chir. 1997;122(12):1065–1071. [PubMed] [Google Scholar]
- Roberts J. R., Blum M. G., Arildsen R., Drinkwater D. C., Jr, Christian K. R., Powers T. A., Merrill W. H. Prospective comparison of radiologic, thoracoscopic, and pathologic staging in patients with early non-small cell lung cancer. Ann Thorac Surg. 1999 Oct;68(4):1154–1158. doi: 10.1016/s0003-4975(99)00983-2. [DOI] [PubMed] [Google Scholar]
- Roviaro G. C., Varoli F., Rebuffat C., Sonnino D., Vergani C., Maciocco M., Pastori S. Videothoracoscopic operative staging for lung cancer. Int Surg. 1996 Jul-Sep;81(3):252–254. [PubMed] [Google Scholar]
- Van Schil P. E., Van den Brande F., De Maeseneer M. G. Operative staging of lung cancer. Monaldi Arch Chest Dis. 2000 Aug;55(4):299–304. [PubMed] [Google Scholar]
- Wain J. C. Video-assisted thoracoscopy and the staging of lung cancer. Ann Thorac Surg. 1993 Sep;56(3):776–778. doi: 10.1016/0003-4975(93)90978-q. [DOI] [PubMed] [Google Scholar]
- Yim A. P. Routine video-assisted thoracoscopy prior to thoracotomy. Chest. 1996 Apr;109(4):1099–1100. doi: 10.1378/chest.109.4.1099. [DOI] [PubMed] [Google Scholar]