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World J Gastroenterol. Jan 21, 2016; 22(3): 1289-1296
Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1289
Recent advances in photodynamic diagnosis of gastric cancer using 5-aminolevulinic acid
Noriaki Koizumi, Yoshinori Harada, Takeo Minamikawa, Hideo Tanaka, Eigo Otsuji, Tetsuro Takamatsu
Noriaki Koizumi, Yoshinori Harada, Takeo Minamikawa, Hideo Tanaka, Tetsuro Takamatsu, Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan
Noriaki Koizumi, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan
Noriaki Koizumi, Department of Surgery, Nishijin Hospital, Kyoto 6028319, Japan
Tetsuro Takamatsu, Department of Medical Photonics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan
Author contributions: Koizumi N and Harada Y wrote the paper; Minamikawa T and Tanaka H revised the paper; Otsuji E and Takamatsu T approved the final version of the paper.
Conflict-of-interest statement: The following authors disclose financial relationships relevant to this publication: Koizumi N, Harada Y, Otsuji E and Takamatsu T have filed an international patent application (WO/2013/002350) for a novel imaging strategy to specifically detect accumulated protoporphyrin IX, which is cited in this review.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tetsuro Takamatsu, MD, PhD, Department of Medical Photonics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 6028566, Japan. ttakam@koto.kpu-m.ac.jp
Telephone: +81-75-2515538 Fax: +81-75-2515538
Received: July 29, 2015
Peer-review started: July 30, 2015
First decision: September 9, 2015
Revised: October 4, 2015
Accepted: November 9, 2015
Article in press: November 9, 2015
Published online: January 21, 2016
Processing time: 170 Days and 1.2 Hours
Abstract

Photodynamic diagnosis based on 5-aminolevulinic acid-induced protoporphyrin IX has been clinically applied in many fields based upon its evidenced efficacy and adequate safety. In order to establish a personalized medicine approach for treating gastric cancer patients, rapid intraoperative detection of malignant lesions has become important. Feasibility of photodynamic diagnosis using 5-aminolevulinic acid for gastric cancer patients has been investigated, especially for the detection of peritoneal dissemination and lymph node metastasis. This method enables intraoperative real-time fluorescence detection of peritoneal dissemination, exhibiting higher sensitivity than white light observation without histopathological examination. The method also enables detection of metastatic foci within excised lymph nodes, exhibiting a diagnostic accuracy comparable to that of a current molecular diagnostics technique. Although several complicating issues still need to be resolved, such as the effect of tissue autofluorescence and the insufficient depth penetration of excitation light, this simple and rapid method has the potential to become a useful diagnostic tool for gastric cancer, as well as urinary bladder cancer and glioma.

Keywords: Gastric cancer; Photodynamic diagnosis; 5-aminolevulinic acid; Protoporphyrin IX; Lymph node metastasis; Personalized medicine; Peritoneal dissemination

Core tip: To perform personalized treatment for gastric cancer, rapid intraoperative detection of malignant lesions is desirable. Photodynamic diagnosis based on 5-aminolevulinic acid-induced protoporphyrin IX may help in this regard. This method enables intraoperative real-time fluorescence detection of peritoneal dissemination in gastric cancer patients, exhibiting higher sensitivity than white light observation without histopathological examination. The method also enables detection of metastatic foci within excised lymph nodes, exhibiting a diagnostic accuracy comparable to a current molecular diagnostics technique. This method has the potential to become a useful diagnostic tool for gastric cancer treatment.