Atypical endometrial hyperplasia diagnosed by hysteroscopic photodynamic diagnosis using 5-aminolevulinic acid

Matoba, Yusuke; Banno, Kouji; Kisu, Iori; Tsuji, Kazuhiko

doi:10.1016/j.pdpdt.2019.03.006

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…In comparison, the high diagnostic sensitivity of hysteroscopic resection guided by 5ALA-PDD may contribute to a decrease of lesion omission. Furthermore, 1 AEH lesion was detected only by 5ALA-PDD [22]. Therefore, hysteroscopic resection guided by 5ALA-PDD may assist in difficult-to-diagnose cases of malignancies in the uterine cavity.…”

Section: Discussionmentioning

confidence: 95%

Hysteroscopic Photodynamic Diagnosis Using 5-Aminolevulinic Acid: A High-Sensitivity Diagnostic Method for Uterine Endometrial Malignant Diseases

Matoba

Banno

Kisu

et al. 2020

Journal of Minimally Invasive Gynecology

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Study Objective: To examine the diagnostic accuracy of hysteroscopic photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5ALA) in patients with endometrial cancer and premalignant atypical endometrial hyperplasia. Design: A single-center, open-label, exploratory intervention study. Setting: University Hospital in Japan. Patients: Thirty-four patients who underwent hysteroscopic resection in the Department of Obstetrics and Gynecology at Keio University Hospital.Interventions: Patients were given 5ALA orally approximately 3 hours before surgery and underwent observation of the uterine cavity and endometrial biopsy using 5ALA-PDD during hysteroscopic resection. Specimens were diagnosed histopathologically and the diagnostic sensitivity and specificity of hysteroscopic 5ALA-PDD for malignancy in the uterine cavity was determined. Red (R), blue (B), and green (G) intensity values were determined from PDD images, and the relationships of histopathological diagnosis with these values were used to develop a model for objective diagnosis of uterine malignancy. Measurements and Main Results: Three patients were excluded from the study because of failure of the endoscope system. A total of 113 specimens were collected endoscopically. The sensitivity and specificity of 5ALA-PDD for diagnosis of malignancy in the uterine cavity were 93.8% and 51.9%, respectively. The R/B ratio in imaging analysis was highest in malignant lesions, followed by benign lesions and normal uterine tissue, with significant differences among these groups (p <.05). The R/B and G/B ratios were used in a formula for prediction of malignancy based on logistic regression and the area under the receiver operating characteristic curve for this formula was 0.838. At a formula cutoff value of 0.220, the sensitivity and specificity for diagnosis of malignant disease were 90.6% and 65.4%, respectively. Conclusion: To our knowledge, this is the first study of the diagnostic accuracy of 5ALA-PDD for malignancies in the uterine cavity. Hysteroscopic 5ALA-PDD had higher sensitivity and identifiability of lesions. These findings suggest that hysteroscopic 5ALA-PDD may be useful for diagnosis of minute lesions.

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Section: Discussionmentioning

confidence: 95%

Hysteroscopic Photodynamic Diagnosis Using 5-Aminolevulinic Acid: A High-Sensitivity Diagnostic Method for Uterine Endometrial Malignant Diseases

Matoba

Banno

Kisu

et al. 2020

Journal of Minimally Invasive Gynecology

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“…Furthermore, 5ALA-PDD contributes to identification of minimal lesions in hysteroscopy. We identified minimal AEH lesions using 5ALA-PDD alone to determine the therapeutic policy [20]. Partial hysteroscopic tumor resection combined with hormone therapy using megestrol acetate and medroxyprogesterone acetate achieves high remission rates [21][22][23][24][25], and combination of hysteroscopic 5ALA-PDD with this therapy may further improve treatment outcomes for fertility preservation.…”

Section: Discussionmentioning

confidence: 99%

Complete resection of an endometrial cancer lesion by hysteroscopic tumor resection combined with photodynamic diagnosis: a case report

2020

European Journal of Gynaecological Oncology

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Introduction: Treatment for early endometrial cancer (EC) has been shifting to less invasive surgery, including several reports of hysteroscopic tumor resection. Complete tumor resection is desired in these treatments. Photodynamic diagnosis (PDD) is the technique to increase the complete resection rate by red fluorescence of the lesion and has improved the prognosis of cystoscopic tumor resection for early bladder cancer. In gynecology, we showed that hysteroscopic PDD has high sensitivity for EC. Here, we report a case of EC in which no residual malignant lesions were found pathologically in hysterectomy after hysteroscopic tumor resection with PDD. Case: The patient was 54 years old when she was diagnosed with atypical endometrial hyperplasia by endometrial biopsy, but suspected to have EC on magnetic resonance imaging. Hysteroscopic tumor resection was planned for the definitive diagnosis. PDD was used in hysteroscopic surgery after informed consent was obtained. Under hysteroscopy, a tumefactive lesion was found on the anterior wall of the uterine cavity to near the left oviductal orifice, and was PDD-positive. The PDD-positive lesion was resected completely under hysteroscopy. The hysteroscopic specimen was pathologically diagnosed as endometrioid carcinoma, grade 1. Laparoscopic hysterectomy and bilateral salpingo-oophorectomy were then performed, but no residual malignancy was found in resected specimens. There has been no recurrence at one year after surgery without no adjunct therapy. Conclusion: Complete resection of endometrial cancer was achieved by hysteroscopic tumor resection with PDD. This case suggests that hysteroscopic surgery may be a less invasive treatment option for early EC.

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“…The identification of cancer cells could guide surgical resections [89], similar to what is currently approved for gliomas and bladder cancer [90][91][92][93]. Photodiagnosis has been applied to gynaecologic diseases [10]; however, scarce studies were found regarding endometrial diseases, 5-ALA being the only photosensitiser used [65,[94][95][96].…”

Section: Future Perspectives and Recommendationsmentioning

confidence: 99%

Applications of Photodynamic Therapy in Endometrial Diseases

et al. 2022

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Photodynamic therapy (PDT) is a medical procedure useful for several benign conditions (such as wound healing and infections) and cancer. PDT is minimally invasive, presents few side effects, good scaring, and is able to minimal tissue destruction maintaining organ anatomy and function. Endoscopic access to the uterus puts PDT in the spotlight for endometrial disease treatment. This work systematically reviews the current evidence of PDT’s potential and usefulness in endometrial diseases. Thus, this narrative review focused on PDT applications for endometrial disease, including reports regarding in vitro, ex vivo, animal, and clinical studies. Cell lines and primary samples were used as in vitro models of cancer, adenomyosis and endometrioses, while most animal studies focused the PDT outcomes on endometrial ablation. A few clinical attempts are known using PDT for endometrial ablation and cancer lesions. This review emphasises PDT as a promising field of research. This therapeutic approach has the potential to become an effective conservative treatment method for endometrial benign and malignant lesions. Further investigations with improved photosensitisers are highly expected.

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Atypical endometrial hyperplasia diagnosed by hysteroscopic photodynamic diagnosis using 5-aminolevulinic acid

Cited by 3 publications

References 6 publications

Hysteroscopic Photodynamic Diagnosis Using 5-Aminolevulinic Acid: A High-Sensitivity Diagnostic Method for Uterine Endometrial Malignant Diseases

Hysteroscopic Photodynamic Diagnosis Using 5-Aminolevulinic Acid: A High-Sensitivity Diagnostic Method for Uterine Endometrial Malignant Diseases

Complete resection of an endometrial cancer lesion by hysteroscopic tumor resection combined with photodynamic diagnosis: a case report

Applications of Photodynamic Therapy in Endometrial Diseases

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