Detection of nonpigmented endometriotic lesions with 5-aminolevulinic acid-induced fluorescence

Study Objective. To evaluate the feasibility of fluorescence diagnosis of nonpigmented (red and white) endometriotic lesions with 20 mg/kg of 5-aminolevulinc acid (5-ALA) 5-7 and 10-14 hours before surgery. Design. Prospective analysis (Canadian Task Force classification II-2). Setting. University hospital. Patients. Twenty-four consecutive patients with suspected endometriosis undergoing laparoscopy. Intervention. Laparoscopic surgery under white light illumination and fluorescence diagnosis. Measurements and Main Results. The total number of endometriotic lesions detected under white light illumination was compared with the number of lesions detected with fluorescence diagnosis. Fluorescence diagnosis yielded an overall improvement of 35% in the detection of nonpigmented endometriotic lesions compared with white light illumination. Sensitivity (91%) and specificity (79%) were similar 5-7 and 10- 14 hours before surgery. Conclusion. The dosage of 20 mg/kg body weight of 5-ALA is feasible for fluorescence diagnosis of nonpigmented endometriosis. Sensitivity of fluorescence diagnosis with 20 mg/kg is similar to that achieved with a 30-mg/kg dose. Sensitivity does not change within the application period 5-7 and 10-14 hours before surgery.