Abstract
The incidence of malignant skin tumors is rapidly increasing. Early diagnosis, determining the margins of the tumor, is extremely important to achieve good treatment results. We investigated fluorescence of protoporphyrin IX in skin carcinomas. The study aimed to compare the effectiveness of topical 5-aminolevulinic acid and methyl-aminolevulinate in determining the exact margins of skin tumors. Fluorescence measurements were performed in 126 patients with malignant, premalignant, and benign skin lesions for detection of the margins of squamous cell carcinoma and basal cell carcinoma. 5-Aminolevulinic acid or its methyl ester was applied to the skin lesion for 2-4 h, and the data of evaluated protoporphyrin IX fluorescence were correlated with the data of morphological tissue examination. Malignant tissue shows a specific red fluorescence when illuminated with blue-violet light, whereas no fluorescence was observed in normal skin. In 30% of cases, the delineation of neoplastic lesions excited by 5-aminolevulinic acid was slightly weaker than using methyl-aminolevulinate. A sensitivity of 95.4% and a specificity of 88.6% as well as positive and negative predictive values of 86.1% and 96.3%, respectively, were obtained. Fluorescence diagnostics can be used for complete visualization of malignant skin lesions after topical application of 5-aminolevulinic acid or methyl aminolevulinate. It has been shown to be highly effective in the diagnostics of malignant superficial skin lesion. This method is applicable for detecting early superficial tumors, margins of tumors, and follow-up after therapy. Topical application of methyl aminolevulinate is slightly superior to 5-aminolevulinic acid in detection of lesion margins.
Highlights
Fluorescence measurements were performed in 126 patients with malignant, premalignant, and benign skin lesions for detection of the margins of squamous cell carcinoma and basal cell carcinoma. 5-Aminolevulinic acid or its methyl ester was applied to the skin lesion for 2–4 h, and the data of evaluated protoporphyrin IX fluorescence were correlated with the data of morphological tissue examination
In 30% of cases, the delineation of neoplastic lesions excited by 5-aminolevulinic acid was slightly weaker than using methyl-aminolevulinate
Fluorescence diagnostics can be used for complete visualization of malignant skin lesions after topical application of 5-aminolevulinic acid or methyl aminolevulinate
Summary
Jurgita Liutkevičiūtė Navickienė, Aleksandras Mordas, Saulė Šimkutė, Laima Bloznelytė-Plėšnienė. Raktažodžiai: fluorescencinė diagnostika, 5-aminolevulininė rūgštis, metilo aminolevulinatas, odos navikai, protoporfirinas IX. Fluorescencinė diagnostika atlikta 126 ligoniams, diagnozuojant ir nustatant tikslias odos plokščialąstelinio, bazoląstelinio vėžio bei ikivėžinių darinių ribas. 5-aminolevulininės rūgšties ar metilo aminolevulinato kremo buvo tepama ant įtartino odos darinio ir laikoma 2–4 val. 5-aminolevulininės rūgšties ar jos metilinto esterio aplikacinė fluorescencinė diagnostika yra patikimas metodas piktybinių epitelinių odos navikų vaizdinimui. Atsižvelgiant į tai, kad nėra pakankamai duomenų apie PpIX sukeltą fluorescenciją pažeistoje bei sveikoje odoje [12], šio tyrimo tikslas – palyginti ALA ir MAL galimybes, fluorescencinėse odos navikų diagnostikose tapatumus bei skirtumus. Tirtųjų kontingentas ir tyrimai Fluorescencinė diagnostika atlikta 126 ligoniams Vilniaus universiteto Onkologijos instituto Lazerinės ir fotodinaminės terapijos laboratorijoje, diagnozuojant ir nustatant tikslias plokščialąstelinės, bazoląstelinės karcinomos bei ikivėžinių darinių ribas.
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