Intraoperative fluorescence diagnosis using 5-aminolevulinic acid in surgical treatment of children with recurrent neuroepithelial tumors

OBJECTIVE: Identification of parathyroid glands is often a challenge even for experienced surgeons. The feasibility and efficacy of fluorescence diagnosis for localization of parathyroids has already been proven in an experimental setting. In preparation for a clinical application of this technique in patients undergoing surgery for hyperparathyroidism, we evaluated the kinetics of fluorescence diagnosis. DESIGN AND METHODS: Fifty rats were randomized into eight groups with different photosensitization parameters using the photosensitizer aminolevulinic acid (ALA): a peritoneal lavage was performed with either 1.5 or 3.0% ALA solution and the induced photosensitization times varied from 0.5, 1 and 2 to 4 h. Under special fluorescence illumination, D-light, the exposed operative site with thyroid, parathyroid glands and neck muscles was examined. The identified parathyroid glands were studied according to fluorescence intensity by spectrometric measurement and compared with surrounding tissue. RESULTS: Photosensitizer accumulation in parathyroid glands, indirectly measured by spectrometry, was up to 3.2 times higher than in thyroid and 2.6 times higher than in muscle tissue (2 h photosensitization with 3.0% ALA). Using 1.5% ALA, the optimum fluorescence intensity and ratio/contrast was slightly lower (parathyroid-to-thyroid ratio x 3.0, parathyroid-to-muscle ratio x 1.9) but was reached earlier (1 h) and hence considered as the parameter of choice for a clinical application. CONCLUSIONS: In future clinical application, intraoperative fluorescence diagnosis is expected to increase the ease of identification of atypically located or supernumeric glands. In combination with preoperative diagnostics, this may result in reduced operation time and avoidance of persistent hypercalcaemia.

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INTRAOPERATIVE FLUORESCENCE DIAGNOSIS OF PERITONEAL DISSEMINATION IN PATIENTS WITH GASTRIC CANCER

Biomedical Photonics ◽

10.24931/2413-9432-2016-5-3-9-18 ◽

2016 ◽

Vol 5 (3) ◽

pp. 9-18 ◽

Cited By ~ 1

Author(s):

E. A. Suleymanov ◽

A. D. Kaprin ◽

E. V. Filonenko ◽

V. M. Homyakov ◽

N. A. Grishin ◽

...

Keyword(s):

Gastric Cancer ◽

Aminolevulinic Acid ◽

Peritoneal Dissemination ◽

Active Agent ◽

Stage Iii ◽

Cancer Stage ◽

Fluorescence Diagnosis ◽

Tumor Dissemination ◽

Standard Laparoscopy ◽

Intraoperative Fluorescence

The study of diagnostic efficiency of intraoperative ﬂuorescence diagnosis (IOFD) of peritoneal dissemination in patients with gastric cancer comparing with standard laparoscopy was performed in P.A. Hertsen MCRI (the branch of NMRRC). The study included 114 patients with veriﬁed diagnosis of gastric cancer stage III–IV. For IOFD the domestic medication alasens (the active agent – 5-aminolevulinic acid) was used orally at dose of 30 mg/kg body weight 3 h prior to the study procedure. As the result of ﬂuorescence diagnosis 10 (6.9%) patients had peritoneal tumor dissemination veriﬁed morphologically and undetected by standard laporoscopy. The sensitivity of peritoneal revision for standard laparoscopy in patients with gastric cancer stage III–IV was 60.8%, the speciﬁcity – 75.8%, the overall accuracy – 69.1%. The sensitivity for IOFD in patients with gastric cancer stage III–IV was 91.1%, the speciﬁcity – 93.9%, the overall accuracy – 92.7%. Thus, ﬂuorescence study allowed improving the speciﬁcity, the sensitivity and the overall accuracy of diagnostic test. In the trial IOFD had the maximal diagnostic value in patients with visually undetectable microdissemination in «whight» light and with solitary visible peritoneal foci (the average number of additionally detected metastatic lesions in one patient – 1.22 and 1.4, respectively). Moreover, in the case of ﬂuorescence diagnosis the number of detected microfoci of peritoneal dissemination was showed to increase with enlargement of area of tumor invasion to gastric serosa (at average of 2.29 additionally detected lesions in one patient with serosal invasion more than 2 cm2). The obtained results conﬁrm the perspective of use of ﬂuorescence diagnosis for detection of peritoneal dissemination, determination of true tumor extent, staging of the tumor and also for adjustment of following treatment tactics for this group of patients.

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Fluorescence-Guided Surgery in the Surgical Treatment of Gliomas: Past, Present and Future

Cancers ◽

10.3390/cancers13143508 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3508

Author(s):

Rosa Sun ◽

Hadleigh Cuthbert ◽

Colin Watts

Keyword(s):

Surgical Treatment ◽

Surgical Resection ◽

Patient Outcomes ◽

Aminolevulinic Acid ◽

Guided Surgery ◽

Improved Outcomes ◽

Fluorescence Guided Surgery ◽

Central Nervous Systems ◽

Extent Of Surgical Resection ◽

Disease Free

Gliomas are central nervous systems tumours which are diffusely infiltrative and difficult to treat. The extent of surgical resection is correlated with improved outcomes, including survival and disease-free progression. Cancerous tissue can be directly visualised intra-operatively under fluorescence by administration of 5-aminolevulinic acid to the patient. The adoption of this technique has allowed surgeons worldwide to achieve greater extents of resection, with implications for improved prognosis. However, there are practical limitations to use of 5-aminolevulinic acid. New adjuncts in the field of fluorescence-guided surgery aim to improve recognition of the interface between tumour and brain with the objective of improving resection and patient outcomes.

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