Fluorescence cytology with 5-aminolevulinic acid in EUS-guided FNA as a method for differentiating between malignant and benign lesions (with video).

Abstract

BACKGROUND:

EUS-guided FNA (EUS-FNA) has been increasingly performed to obtain specimens for the pathological evaluation of patients with GI and pancreaticobiliary masses as well as lymphadenopathies of unknown origin. Photodynamic diagnosis by using 5-aminolebulinic acid (ALA) has been reported to be useful for enabling the visual differentiation between malignant and normal tissue in various cancers.

OBJECTIVE:

To evaluate the diagnostic accuracy of fluorescence cytology with ALA in EUS-FNA.

DESIGN:

A prospective study.

SETTING:

A single center.

PATIENTS:

A total of 28 consecutive patients who underwent EUS-FNA for the pathological diagnosis of a pancreaticobiliary mass lesion or intra-abdominal lymphadenopathy of unknown origin.

INTERVENTIONS:

Patients were orally administered ALA 3 to 6 hours before EUS-FNA. The sample was obtained via EUS-FNA for fluorescence cytology and conventional cytology. A single gastroenterologist performed the fluorescence cytology by using fluorescence microscopy after the procedure, independently of the conventional cytology by pathologists.

MAIN OUTCOME MEASUREMENTS:

The accuracy of fluorescence cytology with ALA in the differentiation between benign and malignant lesions by comparing the results of fluorescence cytology with the final diagnosis.

RESULTS:

Of the 28 patients included in the study, 22 were considered as having malignant lesions and 6 patients as having benign lesions. Fluorescence cytology could correctly discriminate between benign and malignant lesions in all patients. Therefore, both the sensitivity and specificity of fluorescence cytology were 100% in our study.

LIMITATIONS:

Fluorescence cytology was performed by only 1 gastroenterologist with a small number of patients.

CONCLUSION:

Fluorescence cytology with ALA in EUS-FNA may be an effective and simple method for differentiating between benign and malignant lesions.

• Authors: Tsukasa Ikeura, Makoto Takaoka, Kazushige Uchida, Masaaki Shimatani, Hideaki Miyoshi, Kota Kato, Chisato Ohe, Yoshiko Uemura, Masaki Kaibori, A-Hon Kwon, Kazuichi Okazaki
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 81 Issue 6 Pg. 1457-62 ( 2015) ISSN: 1097-6779 [Electronic] United States
• PMID: 25865388 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Video-Audio Media)
• Copyright: Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Chemical References

• Photosensitizing Agents
• Aminolevulinic Acid

Topics

• Adult
• Aged
• Aminolevulinic Acid (administration & dosage)
• Cytological Techniques (instrumentation, methods)
• Diagnosis, Differential
• Endoscopic Ultrasound-Guided Fine Needle Aspiration (methods)
• Female
• Fluorescence
• Humans
• Lymphatic Diseases (diagnosis, pathology)
• Male
• Middle Aged
• Pancreatic Neoplasms (diagnosis, pathology)
• Photosensitizing Agents (administration & dosage)
• Prospective Studies