Preoperative Prediction of Whether Intraoperative Fluorescence of Protoporphyrin IX Can Be Achieved by 5-Aminolevulinic Acid Administration

Satoshi Utsuki,Masahiro Ishizuka,Kiyotaka Fujii,Madoka Inukai,Chihiro Kijima,Hidehiro Oka,Katsushi Inoue,Kiwamu Takahashi

doi:10.4236/ijcm.2012.32026

Satoshi Utsuki, Masahiro Ishizuka + Show 6 more

Open Access

https://doi.org/10.4236/ijcm.2012.32026

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Abstract

Protoporphyrin IX (PPIX) fluorescence-guided brain tumor resection, using 5-aminolevulinic acid (5-ALA), is among the most valuable tools for determining tumor removal area. However, PPIX fluorescence is not necessarily achieved during an operation visually even when 5-ALA is used, and we do not know until tumor exposure to the excitation light of the ultraviolet region whether PPIX fluorescence has been achieved. When a particular biopsy and frozen section diagnosis is made, the reason for lack of PPIX fluorescence in the tissue cannot be judged. We do not know whether the tumor fails to fluoresce or no fluorescence is seen because it is not the main body of the tumor. We investigated whether the presence or absence of tumor fluorescence could be predicted by examining urinary porphyrin before surgery, at the time of intraoperative fluorescence diagnosis using 5-ALA. The urine of brain tumor patients 2 hours after 5-ALA administration was irradiated with a 405 ± 1 nm laser light. The patients were divided into a fluorescent urine group and negative fluorescent urine group. Red fluorescence was observed in response to the 405 ± 1 nm laser beam for all tumors in the fluorescent urine group. Clear red fluorescence was not observed even with 405 ± 1 nm laser beam irradiation in any tumors in the negative fluorescent urine group. Preoperative prediction of the intraoperative fluorescence of PPIX can be achieved by observation of urine 2 hours after 5-ALA administration with exposure to a 405 ± 1 nm laser light.

Highlights

Protoporphyrin IX (PPIX) fluorescence-guided brain tumor resection using 5-aminolevulinic acid (5-ALA) is among the most useful tools for determining the removal area for infiltrating tumors like gliomas [1,2,3,4]
We investigated whether the presence or absence of tumor fluorescence could be predicted by examining urinary porphyrin before surgery, at the time of intraoperative fluorescence diagnosis using 5-ALA
We examined the possibility of predicting abundant PPIX production within tumor cells by a simple method allowing easy detection of urinary coproporphyrin

Summary

Introduction

Protoporphyrin IX (PPIX) fluorescence-guided brain tumor resection using 5-aminolevulinic acid (5-ALA) is among the most useful tools for determining the removal area for infiltrating tumors like gliomas [1,2,3,4]. There is no method of ascertaining preoperatively whether PPIX fluorescence of the tumor tissue will be observed until exposure to an excitation light of the ultraviolet region during tumor resection. In a tumor showing strong PPIX fluorescence, the fluorescence around the tumor is reportedly vague [2]. Whether the resected region is the main body of the tumor or the peripheral zone intraoperatively can be judged before the operation if the tumor shows strong fluorescence, or not. It has been suggested that the biopsy region is not the main body of the tumor when only weakly fluorescent PPIX is observed in tumor biopsy samples. Coproporphyrin productions reportedly increase via the process generating PPIX within tumor cells after administration of 5-ALA [1,5]. We examined the possibility of predicting abundant PPIX production within tumor cells by a simple method allowing easy detection of urinary coproporphyrin

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