Blue light illumination for minimally-invasive fluorescence detection of tumours: technology, clinical experience and future perspectives

Abstract

Endoscopic detection and differentiation of benign, precancerous and malignant tissue is difficult, especially in gastroenterology. Photodynamic techniques utilising tumour-specific fluorescence, e.g. induced by aminolevulinic acid (AM) / protoporphyrin IX (PplX), have been used to visualise and assess lesions. Originally requiring sophisticated laser technology, innovative excitation light sources have been recently developed for photodynamic diagnosis (PDD) to facilitate and broaden its clinical use. The characteristics of one of these devices, the D-Light (Karl Storz, Germany), are described. Current clinical applications and future perspectives of PDD are discussed.

Fluorescence-guided minimally invasive parathyroidectomy: a novel detection technique for parathyroid glands

“…The D-Light system is based on a 300-W xenon short arc lamp with special optical properties designed to focus high intensities of light. It allows two different illumination modes: a conventional white light mode and a specific blue light (380-440 nm) mode for ALA fluorescence excitation [5].…”

Thoracoscopic fluorescence diagnosis (TFD) of pleural malignancies: experimental studies

“…Neurosurgeons also use fluorescence for the intraoperative detection of malignant gliomas, while in dermatology efforts have been maintained to diagnose and demarcate, for example, basal cell carcinoma. 5 Our previous investigations were conducted to evaluate laparoscopic fluorescence diagnosis for gastrointestinal tumour staging. [4][5][6][7] Using the same technical equipment as for the present study, we were able to show a distinctly higher rate of detection of lesions of a disseminated peritoneal carcinosis than with conventional laparoscopy alone.…”

“…ALA induced PpIX photosensitisation has several advantages: (1) ALA, PpIX, and other Time between ALA application and TFD (h) 6 5.4 5. 5 6.1 7.2 11.7 11.0 3.0%…”

“…The modes can easily be switched any time by a footswitch or directly by a button on the CCD camera head. 5 The right diaphragm was incised and the laparoscope was introduced into the pleural space ( fig 2). Complete examination of the entire pleural cavity was performed using white light.…”

“…The positive red fluorescence of PpIX is even detectable in macroscopically invisible tumour foci and can indicate lesions which would be missed when illuminated with conventional white light only. [4][5][6][7][8] …”