Feasibility and diagnostic impact of fluorescence-based diagnostic laparoscopy in hepatocellular carcinoma: a case...

Fluorescence-based diagnostic techniques are an evolving field in the staging of hepatologic and gastroenterologic malignancies. The method aims at improved accuracy in the detection of locoregional and distant metastases. In hepatocellular carcinoma, detection of metastases is of utmost importance, because advanced tumors preclude curative surgical therapy. We present here our first experience of fluorescence-based diagnostic laparoscopy in a patient with hepatocellular carcinoma. We performed diagnostic laparoscopy in a 76-year-old woman who presented with a tumor of the liver and increased serum levels of alpha-fetoprotein. For photosensitization, 5-aminolevulinic acid (20 mg/kg bodyweight, p.o.) was used 6 hours prior to laparoscopy, which was performed with a prograde 0 degree telescope suitable for fluorescence-based laparoscopy. The D-Light AF system was used as a light source. Laparoscopy was carried out according to common guidelines in the white-light as in the blue-light mode. The main tumor and the satellite metastases clearly showed intense fluorescence compared with unaffected liver parenchyma and other abdominal organs. Fluorescence-based laparoscopy identified several small metastases which had been missed during conventional white-light illumination. Hepatocellular carcinoma was confirmed by the histological examination of several biopsies drawn from suspicious areas. Fluorescence-based laparoscopy provided additional information in the staging of hepatocellular carcinoma. The technique can further improve diagnostic accuracy in the staging of hepatocellular carcinoma, particularly in patients potentially suitable for partial liver resection or transplantation.