臨床泌尿器科63巻11号

2009年10月発行

綜説

Photodynamic diagnosis（PDD）の泌尿器科領域への臨床的応用

著者： 松山豪泰¹

所属機関： ¹山口大学大学院医学系研究科泌尿器科学分野

ページ範囲：P.855 - P.859

文献概要

要旨　Photodynamic diagnosis（PDD）は泌尿器科領域では膀胱上皮内癌（CIS）などの平坦病変を診断する蛍光膀胱鏡検査がその代表であり，EAUガイドラインにおいてもCISが疑われる膀胱癌の診断においてはPDDを考慮すべきであると記されている。本論文ではPDDのこれまでの歴史，蛍光発生のメカニズム，利点と欠点，現在形成されつつあるPDDに関するエビデンス，さらに今後の応用について概説した。PDDはCIS病変診断の感度が高く，今後PDD併用TURBTの臨床応用が期待できる一方，偽陽性の解明，薬剤や機器の承認が今後の問題点としてあげられる。

参考文献

. Eur Urol 48：363-371, 2005

2）井上啓史，辛島　尚，鎌田雅行，他：5-アミノレブリン酸（5-ALA）膀胱内注入による蛍光膀胱鏡を用いた膀胱癌の光力学的診断．日泌総会誌 97：719-729，2006

3）Rall DP, Loo T, Lane M, et al：Appearance and persistence of fluorescent material in tumor tissue after tetracycline administration. J Natl Cancer Inst 19：79-85, 1957

4）Kelly JF：Haematoporphyrins in the diagnosis and treatment of carcinoma of the bladder. Proc R Soc Med 68：527-528, 1975

5）Baumgartner R, Fisslinger H, Jocham D, et al：A fluorescence imaging device for endoscopic detection of early stage cancer：instrumental and experimental studies. Photochem Photobiol 46：759-763, 1987

6）Nseyo UO, Dougherty TJ, Boyle DG, et al：Whole bladder photodynamic therapy for transitional cell carcinoma of bladder. Urology 26：274-280, 1985

7）Kriegmair M and Baumgartner R：Intravesikuläre Instillation von Delta-Aminolavulinsäure（ALA）-Eine neue Methode zur photodynamischen Diagnostik und Therapie. Laser Medizin 8：83, 1992

8）Fotinos N, Campo MA, Popowycz F, et al：5-Aminolevulinic acid derivatives in photomedicine：characteristics, application and perspectives. Photochem Photobiol 82：994-1015, 2006

9）松山豪泰，原　智彦，江口　賢，他：膀胱腫瘍に対する光線力学療法と蛍光膀胱鏡検査．Jpn J Endourol ESWL 20：43-49，2007

10）Batlle AM：Porphyrins, porphyrias, cancer and photodynamic therapy：a model for carcinogenesis. J Photochem Photobiol B 20：5-22, 1993

11）Fukuda H, Casas A and Batlle A：Aminolevulinic acid：from its unique biological function to its star role in photodynamic therapy. Int J Biochem Cell Biol 37：272-276, 2005

12）Kriegmair M, Baumgartner R, Knüchel R, et al：Detection of early bladder cancer by 5-aminolevulinic acid induced porphyrin fluorescence. J Urol 155：105-109, 1996

13）Koenig F, McGovern FJ, Larne R, et al：Diagnosis of bladder carcinoma using protoporphyrin Ⅸ fluorescence induced by 5-aminolevulinic acid. BJU Int 83：129-135, 1999

14）Filbeck T, Roessler W, Knuechel R, et al：Clinical results of the transurethral resection and evaluation of superficial bladder carcinomas by means of fluorescence diagnosis after intravesical instillation of 5-aminolevulinic acid. J Endourol 13：117-121, 1999

15）Riedl CR, Plas E and Pflüger H：Fluorescence detection of bladder tumors with 5-amino-levulinic acid. J Endourol 13：755-759, 1999

16）Zaak D, Hungerhuber E, Schneede P, et al：Role of 5-aminolevulinic acid in the detection of urothelial premalignant lesions. Cancer 95：1234-1238, 2002

17）Grimbergen MC, van Swol CF, Jonges TG, et al：Reduced specificity of 5-ALA induced fluorescence in photodynamic diagnosis of transitional cell carcinoma after previous intravesical therapy. Eur Urol 44：51-56, 2003

18）Hungerhuber E, Stepp H, Kriegmair M, et al：Seven years' experience with 5-aminolevulinic acid in detection of transitional cell carcinoma of the bladder. Urology 69：260-264, 2007

19）Grossman HB, Gomella L, Fradet Y, et al；PC B302/01 Study Group：A phase Ⅲ, multicenter comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of superficial papillary lesions in patients with bladder cancer. J Urol 178：62-67, 2007

20）Tritschler S, Scharf S, Karl A, et al：Validation of the diagnostic value of NMP22 BladderCheck test as a marker for bladder cancer by photodynamic diagnosis. Eur Urol 51：403-408, 2007

21）Filbeck T, Roessler W, Knuechel R, et al：5-aminolevulinic acid-induced fluorescence endoscopy applied at secondary transurethral resection after conventional resection of primary superficial bladder tumors. Urology 53：77-81, 1999

22）Hartmann A, Moser K, Kriegmair M, et al：Frequent genetic alterations in simple urothelial hyperplasias of the bladder in patients with papillary urothelial carcinoma. Am J Pathol 154：721-727, 1999

23）Obermann EC, Junker K, Stoehr R, et al：Frequent genetic alterations in flat urothelial hyperplasias and concomitant papillary bladder cancer as detected by CGH, LOH, and FISH analyses. J Pathol 199：50-57, 2003

experiment. Oncology 76：118-125, 2009

25）Denzinger S, Burger M, Walter B, et al：Clinically relevant reduction in risk of recurrence of superficial bladder cancer using 5-aminolevulinic acid-induced fluorescence diagnosis：8-year results of prospective randomized study. Urology 69：675-679, 2007

26）Babjuk M, Soukup V, Petrík R, et al：5-aminolaevulinic acid-induced fluorescence cystoscopy during transurethral resection reduces the risk of recurrence in stage Ta/T1 bladder cancer. BJU Int 96：798-802, 2005

27）Daniltchenko DI, Riedl CR, Sachs MD, et al：Long-term benefit of 5-aminolevulinic acid fluorescence assisted transurethral resection of superficial bladder cancer：5-year results of a prospective randomized study. J Urol 174：2129-2133, 2005

28）Schneede P, Münch P, Wagner S, et al：Fluorescence urethroscopy following instillation of 5-aminolevulinic acid：a new procedure for detecting clinical and subclinical HPV lesions of the urethra. J Eur Acad Dermatol Venereol 15：121-125, 2001

29）Frimberger D, Schneede P, Hungerhuber E, et al：Autofluorescence and 5-aminolevulinic acid induced fluorescence diagnosis of penile carcinoma：new techniques to monitor Nd:YAG laser therapy. Urol Res 30：295-300, 2002

30）Popken G, Wetterauer U and Schultze-Seemann W：Kidney-preserving tumour resection in renal cell carcinoma with photodynamic detection by 5-aminolaevulinic acid：preclinical and preliminary clinical results. BJU Int 83：578-582, 1999

31）Jocham D, Stepp H and Waidelich R：Photodynamic diagnosis in urology：state-of-the-art. Eur Urol 53：1138-1148, 2008