Chest
Clinical InvestigationsFiberoptic Bronchoscopic Laser Photoradiation for Tumor Localization in Lung Cancer
Section snippets
MATERIALS AND METHODS
Of 17 patients, 16 showed malignant cells on sputum cytology examination, and one showed findings suspicious of malignancy. Two patients (cases 1 and 17) were x-ray negative; however, abnormal results were found in all 17 patients on fiberoptic bronchoscopic examinations. Punch biopsies and brushing cytology via the fiberoptic bronchoscope were performed in all cases, yielding a histologic diagnosis of squamous cell carcinoma in nine cases, two adenocarcinoma, two small cell carcinoma, three
RESULTS
The fluorescence from endobronchial tumors was classified into four grades as follows: grade 0, negative; grade 1, obscure; grade 2, diffuse; and grade 3, well-defined. The results obtained are summarized in Table 1. All patients were examined first by routine fiberoptic bronchoscopy with a conventional light source, then using laser photoradiation. Grades 2 and 3 fluorescence were obtained in 13 cases (cases 1–8, 10, 12, 14, 16 and 17), one case was grade 1 (13), and three cases (9, 11, and
DISCUSSION
Hematoporphyrin derivative (HpD) has a strong affinity for cancer tissue and is retained longer in malignant tissue than in normal tissue.2, 4, 10 Therefore HpD has the potential of a carcinoma-specific marker, and localization of carcinoma by detection of HpD fluorescence may be possible.3, 11, 12, 13 Thus, observation of HpD fluorescence via the fiberoptic bronchoscope is a possible means of detection and localization of bronchogenic carcinoma.
The first attempt to observe fluorescence of
ACKNOWLEDGMENT
The authors wish to express their deep gratitude to Drs. Thomas J. Dougherty and Kenneth R. Weishaupt of Roswell Park Memorial Institute, who supplied us with HpD and provided much helpful advice, and Associate Professor J. P. Barron of St. Marianna University School of Medicine for his review of the manuscript.
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Supported in part by a grant-in-aid for Scientific Research from the Ministry of Education and Welfare, Japan, and by the Cancer Research Fund of Tokyo Medical College Cancer Center.
Manuscript received September 4; revision accepted December 1