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Comparison of efficiency of photodynamic diagnostics with topical use of the 3% and 15% aminolevulinic acid in the detection of vulvar lesions

机译：比较光动力诊断与局部使用3％和15％氨基乙酰丙酸检测外阴病变的效率

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摘要

The essence of the photodynamic diagnostic method is interaction between light and chemical compounds that form in reaction to light. In order to obtain fluoresecence, tissue has to be exposed to energy in the form of light with the wavelength corresponding to the bandwidth of the photosensitizer absorption. The photodynamic method allows for the detection of even small lesions. This method facilitates the process of detecting vulvar cancer, especially in its early stages when it can develop on the foundation of overgrown epithelium. At that point the vulvoscopic image is difficult to interpret, in particular when multifocal growth occurs. Objectives: The objective of the study was evaluating the efficiency of the photodynamic method PDD (photodynamic diagnosis) in the detection of vulvar lesions when two concentrations of the photosensitizer were used (3%- and 15%-aminolevulinic acid), as well as evaluating the efficiency of this method when compared to the efficiency of vulvoscopy, against the result of histological examination. Methods: Two concentrations of the 5-ALA cream (aminolevulinic acid) - 3% and 15% - were used in the PDD testing. The study group was divided into two subgroups A and B. In subgroup A the 15% eucerine-based cream was used. In subgroup B the 3% ALA gel with and addition of 2% DSMO was used. The photosensitizer was applied to the vulva 4-6 h before the examination. In order to obtain fluorescence, energy in the form of light whose wavelength was approximately 405 nm, and whose source was a SLED diode, was transmitted to vulvar tissue. The positive result of the exam was obtaining tissue fluorescence. All patients underwent vulvoscopy and a histological examination of tissue samples was performed in all cases. The efficiency of the photodynamic testing in subgroups A and B was compared with the efficiency of vulvoscopy, against the result of histological examination. Sensitivity, specificity, as well as positive and negative predictive values of the PDD examination and vulvoscopy in both subgroups, were evaluated. Results: When the 15% ALA was used in detecting vulvar lesions, the photodynamic diagnostics was characterized by sensitivity of 100%, specificity of 92%, positive predictive value of 80%, negative predictive value of 100%, and correlation with the histopathological examination of 93.9%. When the 3% ALA was used, we observed: sensitivity of 100%, specificity of 91.4%, positive predictive value of 78.5%, negative predictive value of 100%, and correlation with the histopathological examination of 93.4%. Differences in the two subgroups were not statistically significant. Conclusions: High correlation was observed between the accuracy of the photodynamic method of examining vulvar lesions and the accuracy of the histological examination, especially in cases of precancerous lesions and vulvar cancer. The photodynamic examination, when the 3%-ALA/2%DSMO is used, is characterized by a greater sensitivity, comparable specificity, as well as, comparable positive and negative prognostic values, in comparison to the vulvoscopic examination. The photodynamic method, when used with other diagnostic methods, facilitates performing the needle aspiration biopsy and allows for a greater precision of histological diagnoses. The pathological fluorescence obtained during the PDD examination gives information about the spread and multifocality of vulvar lesions, which can facilitate making presurgical decisions concerning the extensiveness of surgery. The photodynamic method, when the 3% ALA/2% DSMO is applied topically, is of comparable efficiency as the 15% ALA, in the detection of vulvar lesions. High safety of the photodynamic method was shown, both in terms of the topical application of the aminolevulinic acid and the subsequent use of light.
机译：光动力诊断方法的本质是光与对光反应形成的化合物之间的相互作用。为了获得荧光，组织必须以光的形式暴露于能量，该光的波长对应于光敏剂吸收的带宽。光动力方法甚至可以检测出很小的病变。这种方法有助于检测外阴癌，特别是在上皮细胞过度生长的早期阶段。在这一点上，尤其是当发生多焦点生长时，难以解释外阴镜图像。目的：本研究的目的是评估使用两种浓度的光敏剂（3％-和15％-氨基乙酰丙酸）时光动力学方法PDD（光动力学诊断）在检测外阴病变中的效率，并评估与阴道镜检查的效率相比，此方法的效率与组织学检查结果相反。方法：在PDD测试中使用两种浓度的5-ALA乳膏（氨基乙酰丙酸）分别为3％和15％。研究组分为A和B两个亚组。在A亚组中，使用了15％的基于黄嘌呤的乳膏。在亚组B中，使用3％ALA凝胶和2％DSMO。在检查前4-6小时将光敏剂施用于外阴。为了获得荧光，将波长为约405nm且源为SLED二极管的光形式的能量传输至外阴组织。检查的积极结果是获得组织荧光。所有患者均进行了阴道镜检查，所有病例均进行了组织样本的组织学检查。将A和B亚组的光动力测试效率与阴道镜检查效率进行比较，以与组织学检查结果进行比较。评价了两个亚组中PDD检查和阴道镜检查的敏感性，特异性以及阳性和阴性预测值。结果：使用15％ALA检测外阴病变时，其光动力学诊断的特征是灵敏度为100％，特异性为92％，阳性预测值为80％，阴性预测值为100％并与组织病理学检查相关93.9％。当使用3％ALA时，我们观察到：敏感性为100％，特异性为91.4％，阳性预测值为78.5％，阴性预测值为100％，并且与组织病理学检查的相关性为93.4％。两个亚组的差异在统计学上不显着。结论：光动力学方法检查外阴病变的准确性与组织学检查的准确性之间存在高度相关性，尤其是在癌前病变和外阴癌病例中。与阴道镜检查相比，当使用3％-ALA / 2％DSMO时，光动力学检查的特点是灵敏度更高，可比的特异性以及可比的阳性和阴性预后值。当与其他诊断方法一起使用时，光动力学方法有助于进行穿刺活检并允许组织学诊断更高的精度。在PDD检查过程中获得的病理荧光可提供有关外阴病变扩散和多灶性的信息，这有助于做出有关手术范围的术前决策。当局部应用3％ALA / 2％DSMO时，光动力法在检测外阴病变方面的效率与15％ALA相当。在局部应用氨基乙酰丙酸和随后使用光方面，都显示出光动力学方法的高安全性。

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  • 来源
    《Photodiagnosis and Photodynamic Therapy》 |2013年第4期|422-428|共7页
  • 作者

    Agnieszka Mazdziarz M.D.; Aleksandra Zielinska; Habib Alkhalayla; Beata Spiewankiewicz;

  • 作者单位

    Department of Female Genital Neoplasms of the Centre of Oncology in Warsaw, 5 Roentgena St.,02-781 Warsaw, Poland;

    Chair and Department of Obstetrics, Gynaecology and Oncology II Faculty of Medicine,Medical University of Warsaw, 8 Kondratowicza St., 03-242 Warsaw, Poland;

    Chair and Department of Obstetrics, Gynaecology and Oncology II Faculty of Medicine,Medical University of Warsaw, 8 Kondratowicza St., 03-242 Warsaw, Poland;

    Department of Female Genital Neoplasms of the Centre of Oncology in Warsaw, 5 Roentgena St.,02-781 Warsaw, Poland;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

    Photodynamic diagnostics; Aminolevulinic acid; Vulvar lesions;

    机译：光动力学诊断;氨基乙酰丙酸;外阴病变;

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