Background: The diagnosis of nonpigmented endometrial lesions by simple lap
aroscopic visualization is difficult and often inaccurate. We therefore sou
ght to establish a new and more accurate method to visualize these nonpigme
nted peritoneal changes caused by endometriosis.
Methods: A total of 37 patients received 30 mg 5-aminolevulinic acid/kg bod
y weight 10 to 14 hs prior to surgery. Laparoscopy was then performed using
a D-Light system (Storz, Tuttlingen, Germany). The findings were evaluated
first in the white-light mode; the D-light system was then activated, and
all areas of fluorescence were documented. Multiple specimens were obtained
by biopsy.
Results: The sensitivity of the fluorescence diagnosis in detecting endomet
riosis in nonpigmented areas and normal-looking peritoneum is 100%, with a
specificity of 75%. Diagnosis by simple visualization under white illuminat
ion has a sensitivity of only 69% and a specificity of 70%. Occult areas of
endometriosis were discovered using fluorescence diagnosis.
Conclusions: Our findings suggest that fluorescence diagnosis using 5-amino
levulinic acid is feasible and can improve the diagnosis of endometriosis i
n nonpigmented and occult endometrial lesions. Fluorescence diagnosis is a
promising new tool in the diagnosis of endometriosis.