Hysteroscopic Photodynamic Diagnosis Using 5-Aminolevulinic Acid: A High-Sensitivity Diagnostic Method for Uterine Endometrial Malignant Diseases
| Autor: | Masaru Nakamura, Shimpei Nagai, Kosuke Tsuji, Kouji Banno, Iori Kisu, Wataru Yamagami, Yusuke Matoba, Eiichiro Tominaga, Daisuke Aoki, Miho Kawaida, Yusuke Kobayashi |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Endoscope Hysteroscopy Malignancy Sensitivity and Specificity Endometrium 03 medical and health sciences 0302 clinical medicine Japan Obstetrics and gynaecology Pregnancy medicine Humans Diagnostic Techniques Obstetrical and Gynecological Atypical Endometrial Hyperplasia Uterine Diseases 030219 obstetrics & reproductive medicine medicine.diagnostic_test business.industry Endometrial cancer Obstetrics and Gynecology Middle Aged medicine.disease Levulinic Acids Endometrial Neoplasms medicine.anatomical_structure 030220 oncology & carcinogenesis Endometrial Hyperplasia Luminescent Measurements Uterine Neoplasms Female Radiology Uterine cavity business Precancerous Conditions Endometrial biopsy |
| Zdroj: | Journal of Minimally Invasive Gynecology. 27:1087-1094 |
| ISSN: | 1553-4650 |
| DOI: | 10.1016/j.jmig.2019.08.012 |
| Popis: | To examine the diagnostic accuracy of hysteroscopic photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5ALA) in patients with endometrial cancer and premalignant atypical endometrial hyperplasia.A single-center, open-label, exploratory intervention study.University Hospital in Japan.Thirty-four patients who underwent hysteroscopic resection in the Department of Obstetrics and Gynecology at Keio University Hospital.Patients were given 5ALA orally approximately 3 hours before surgery and underwent observation of the uterine cavity and endometrial biopsy using 5ALA-PDD during hysteroscopic resection. Specimens were diagnosed histopathologically and the diagnostic sensitivity and specificity of hysteroscopic 5ALA-PDD for malignancy in the uterine cavity was determined. Red (R), blue (B), and green (G) intensity values were determined from PDD images, and the relationships of histopathological diagnosis with these values were used to develop a model for objective diagnosis of uterine malignancy.Three patients were excluded from the study because of failure of the endoscope system. A total of 113 specimens were collected endoscopically. The sensitivity and specificity of 5ALA-PDD for diagnosis of malignancy in the uterine cavity were 93.8% and 51.9%, respectively. The R/B ratio in imaging analysis was highest in malignant lesions, followed by benign lesions and normal uterine tissue, with significant differences among these groups (p.05). The R/B and G/B ratios were used in a formula for prediction of malignancy based on logistic regression and the area under the receiver operating characteristic curve for this formula was 0.838. At a formula cutoff value of 0.220, the sensitivity and specificity for diagnosis of malignant disease were 90.6% and 65.4%, respectively.To our knowledge, this is the first study of the diagnostic accuracy of 5ALA-PDD for malignancies in the uterine cavity. Hysteroscopic 5ALA-PDD had higher sensitivity and identifiability of lesions. These findings suggest that hysteroscopic 5ALA-PDD may be useful for diagnosis of minute lesions. |
| Databáze: | OpenAIRE |
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