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Chen Y, Guo P, Chen L, He D. 5-aminolevulinic acid induced photodynamic reactions in diagnosis and therapy for female lower genital tract diseases. Front Med (Lausanne) 2024; 11:1370396. [PMID: 39076768 PMCID: PMC11284047 DOI: 10.3389/fmed.2024.1370396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/13/2024] [Indexed: 07/31/2024] Open
Abstract
Since the patients suffering from female lower genital tract diseases are getting younger and younger and the human papilloma virus (HPV) infection is becoming more widespread, the novel non-invasive precise modalities of diagnosis and therapy are required to remain structures of the organ and tissue, and fertility as well, by which the less damage to normal tissue and fewer adverse effects are able to be achieved. In all nucleated mammalian cells, 5-Aminolevulinic acid (5-ALA) is an amino acid that occurs spontaneously, which further synthesizes in the heme biosynthetic pathway into protoporphyrin IX (PpIX) as a porphyrin precursor and photosensitizing agent. Exogenous 5-ALA avoids the rate-limiting step in the process, causing PpIX buildup in tumor tissues. This tumor-selective PpIX distribution after 5-ALA application has been used successfully for tumor photodynamic diagnosis (PDD) and photodynamic therapy (PDT). Several ALA-based drugs have been used for ALA-PDD and ALA-PDT in treating many (pre)cancerous diseases, including the female lower genital tract diseases, yet the ALA-induced fluorescent theranostics is needed to be explored further. In this paper, we are going to review the studies of the mechanisms and applications mainly on ALA-mediated photodynamic reactions and its effectiveness in treating female lower genital tract diseases.
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Affiliation(s)
- Yuqing Chen
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi, China
| | - Peng Guo
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi, China
| | - Lihong Chen
- Department of Obstetrics and Gynecology, Shaanxi Provincial People’s Hospital, Xi'an, Shaanxi, China
| | - Dalin He
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi, China
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Gibson C, Wang SC, Phoon A, Thalanki Anantha N, Ottolino-Perry K, Petropoulos S, Qureshi Z, Subramanian V, Shahid A, O'Brien C, Carcone S, Chung S, Tsui T, Son V, Sukhram M, Meng F, Done SJ, Easson AM, Cil T, Reedijk M, Leong WL, DaCosta RS. A handheld device for intra-cavity and ex vivo fluorescence imaging of breast conserving surgery margins with 5-aminolevulinic acid. BMC Biomed Eng 2024; 6:5. [PMID: 38822389 PMCID: PMC11143723 DOI: 10.1186/s42490-024-00079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Visualization of cancer during breast conserving surgery (BCS) remains challenging; the BCS reoperation rate is reported to be 20-70% of patients. An urgent clinical need exists for real-time intraoperative visualization of breast carcinomas during BCS. We previously demonstrated the ability of a prototype imaging device to identify breast carcinoma in excised surgical specimens following 5-aminolevulinic acid (5-ALA) administration. However, this prototype device was not designed to image the surgical cavity for remaining carcinoma after the excised lumpectomy specimen is removed. A new handheld fluorescence (FL) imaging prototype device, designed to image both excised specimens and within the surgical cavity, was assessed in a clinical trial to evaluate its clinical utility for first-in-human, real-time intraoperative imaging during index BCS. RESULTS The imaging device combines consumer-grade imaging sensory technology with miniature light-emitting diodes (LEDs) and multiband optical filtering to capture high-resolution white light (WL) and FL digital images and videos. The technology allows for visualization of protoporphyrin IX (PpIX), which fluoresces red when excited by violet-blue light. To date, n = 17 patients have received 20 mg kg bodyweight (BW) 5-ALA orally 2-4 h before imaging to facilitate the accumulation of PpIX within tumour cells. Tissue types were identified based on their colour appearance. Breast tumours in sectioned lumpectomies appeared red, which contrasted against the green connective tissues and orange-brown adipose tissues. In addition, ductal carcinoma in situ (DCIS) that was missed during intraoperative standard of care was identified at the surgical margin at <1 mm depth. In addition, artifacts due to the surgical drape, illumination, and blood within the surgical cavity were discovered. CONCLUSIONS This study has demonstrated the detection of a grossly occult positive margin intraoperatively. Artifacts from imaging within the surgical cavity have been identified, and potential mitigations have been proposed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01837225 (Trial start date is September 2010. It was registered to ClinicalTrials.gov retrospectively on April 23, 2013, then later updated on April 9, 2020, to reflect the introduction of the new imaging device.).
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Affiliation(s)
- Christopher Gibson
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, 101 College Street, M5G 1L7, Toronto, Canada
| | - Shirley C Wang
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Arcturus Phoon
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Nayana Thalanki Anantha
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Kathryn Ottolino-Perry
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Stephen Petropoulos
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Zuha Qureshi
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Vasanth Subramanian
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Anam Shahid
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Cristiana O'Brien
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
| | - Steven Carcone
- The Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, 10th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Suzanne Chung
- The Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, 10th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Teresa Tsui
- The Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, 10th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Viktor Son
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Mayleen Sukhram
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Fannong Meng
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11th Floor Eaton Wing, M5G 2C4, Toronto, Canada
| | - Susan J Done
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11th Floor Eaton Wing, M5G 2C4, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, M5S 1A8, Toronto, Canada
| | - Alexandra M Easson
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, M5T 2M9, Toronto, Canada
| | - Tulin Cil
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, M5T 2M9, Toronto, Canada
| | - Michael Reedijk
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, M5T 2M9, Toronto, Canada
| | - Wey L Leong
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada
- Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, M5T 2M9, Toronto, Canada
| | - Ralph S DaCosta
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, M5G 1L7, Toronto, Canada.
- Department of Medical Biophysics, University of Toronto, 101 College Street, M5G 1L7, Toronto, Canada.
- Techna Institute, University Health Network, 124-100 College Street, M5G 1P5, Toronto, Canada.
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Risk of Cervical Intraepithelial Neoplasia 2 or Worse by Cytology, Human Papillomavirus 16/18, and Colposcopy Impression: A Systematic Review and Meta-analysis. Obstet Gynecol 2019; 132:725-735. [PMID: 30095780 DOI: 10.1097/aog.0000000000002812] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To calculate pooled risk estimates for combinations of cytology result, human papillomavirus (HPV) 16/18 genotype and colposcopy impression to provide a basis for risk-stratified colposcopy and biopsy practice. DATA SOURCE A PubMed search was conducted on June 1, 2016, and a ClinicalTrials.gov search was conducted on June 9, 2018, using key words such as "uterine cervical neoplasms," "cervical cancer," "mass screening," "early detection of cancer," and "colposcopy." METHODS OF STUDY SELECTION Eligible studies must have included colposcopic impression and either cytology results or HPV 16/18 partial genotype results as well as a histologic biopsy diagnosis from adult women. Manuscripts were reviewed for the following: cytology, HPV status, and colposcopy impression as well as age, number of women, and number of cervical intraepithelial neoplasia (CIN) 2, CIN 3, and cancer cases. Strata were defined by the various combinations of cytology, genotype, and colposcopic impression. TABULATION, INTEGRATION, AND RESULTS Of 340 abstracts identified, nine were eligible for inclusion. Data were also obtained from three unpublished studies, two of which have since been published. We calculated the risk of CIN 2 or worse and CIN 3 or worse based on cytology, colposcopy, and HPV 16/18 test results. We found similar risk patterns across studies in the lowest risk groups such that risk estimates were similar despite different referral populations and study designs. Women with a normal colposcopy impression (no acetowhitening), less than high-grade squamous intraepithelial lesion cytology, and HPV 16/18-negative were at low risk of prevalent precancer. Women with at least two of the following: high-grade squamous intraepithelial lesion cytology, HPV16- or HPV18-positive, and high-grade colposcopic impression were at highest risk of prevalent precancer. CONCLUSION Our results support a risk-based approach to colposcopy and biopsy with modifications of practice at the lowest and highest risk levels.
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DSouza AV, Lin H, Henderson ER, Samkoe KS, Pogue BW. Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:80901. [PMID: 27533438 PMCID: PMC4985715 DOI: 10.1117/1.jbo.21.8.080901] [Citation(s) in RCA: 257] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/19/2016] [Indexed: 05/04/2023]
Abstract
There is growing interest in using fluorescence imaging instruments to guide surgery, and the leading options for open-field imaging are reviewed here. While the clinical fluorescence-guided surgery (FGS) field has been focused predominantly on indocyanine green (ICG) imaging, there is accelerated development of more specific molecular tracers. These agents should help advance new indications for which FGS presents a paradigm shift in how molecular information is provided for resection decisions. There has been a steady growth in commercially marketed FGS systems, each with their own differentiated performance characteristics and specifications. A set of desirable criteria is presented to guide the evaluation of instruments, including: (i) real-time overlay of white-light and fluorescence images, (ii) operation within ambient room lighting, (iii) nanomolar-level sensitivity, (iv) quantitative capabilities, (v) simultaneous multiple fluorophore imaging, and (vi) ergonomic utility for open surgery. In this review, United States Food and Drug Administration 510(k) cleared commercial systems and some leading premarket FGS research systems were evaluated to illustrate the continual increase in this performance feature base. Generally, the systems designed for ICG-only imaging have sufficient sensitivity to ICG, but a fraction of the other desired features listed above, with both lower sensitivity and dynamic range. In comparison, the emerging research systems targeted for use with molecular agents have unique capabilities that will be essential for successful clinical imaging studies with low-concentration agents or where superior rejection of ambient light is needed. There is no perfect imaging system, but the feature differences among them are important differentiators in their utility, as outlined in the data and tables here.
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Affiliation(s)
- Alisha V. DSouza
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
- Address all correspondence to: Alisha V. DSouza, E-mail: ; Brian W. Pogue, E-mail:
| | - Huiyun Lin
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
- Fujian Normal University, MOE Key Laboratory of OptoElectronic Science and Technology for Medicine, Fujian Provincial Key Laboratory for Photonics Technology, Fujian 350007, China
| | - Eric R. Henderson
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire 03756, United States
| | - Kimberley S. Samkoe
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
- Dartmouth College, Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire 03755, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, United States
- Dartmouth College, Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire 03755, United States
- Address all correspondence to: Alisha V. DSouza, E-mail: ; Brian W. Pogue, E-mail:
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