Evaluating Usefulness of 5-Aminolevulinic Acid induced Fluorescence to guide Biopsy of Oral Cancers and Premalignant Lesions

Abstract

Background Oral carcinoma prevalence is high in Kolar owing to tobacco chewing habit. The patients may have premalignant lesions all over oral cavity (field cancerization) making it difficult to select ideal biopsy site. 5-aminolevulinic acid (5-ALA) induced fluorescence helps to demarcate lesions beyond visible margin and helps to choose biopsy site. Objectives To perform separate biopsies from the visible and fluorescent margins of malignant/premalignant lesions of oral cavity following staining with 5- ALA and determine if microscopic tumor extends beyond visible margin. Materials and methods Our study included 50 patients with oral carcinoma/ premalignant lesions. Biopsies were taken from visible and fluorescence margins following incubation period of 3 hours post rinsing with 5-ALA solution. Specimens subjected to histopathological examination for detection of malignant cells. Usefulness of 5-ALA was documented by evaluating sensitivity, specificity, positive and negative predictive values and diagnostic accuracy. Results Fifty patients with age ranging from 33 to 78 years showed female predominance—4:1. Forty-seven patients noted fluorescence beyond visible margin. Tongue malignancies showed maximum extension. Diagnostic sensitivity with 5-ALA was 95.74% and specificity was 100%. Positive and negative predictive values were 100 and 60% respectively. 5-ALA's diagnostic accuracy was determined to be 96%. Conclusion Majority patients showed microscopic tumor extension beyond visible margin. 5-ALA staining helps in determining the true extent of lesion as Protoporphyrin IX accumulation in malignant cells shows fluorescence. This helps in guiding biopsies in field cancerization and adequate surgical tumor clearance thereby improving locoregional control. How to cite this article Ramachandra M, Mohiyuddin SMA, Suresh TN, Sagayaraj A, Merchant S. Evaluating Usefulness of 5-Aminolevulinic Acid induced Fluorescence to guide Biopsy of Oral Cancers and Premalignant Lesions. Int J Head Neck Surg 2015;6(2):64-68.