JPH01151436A - Apparatus for diagnosis and treatment of cancer - Google Patents

Abstract

PURPOSE:To enhance the reliability of the treatment of cancer using photochemical reaction, by monitoring a series of treatment states by detecting infrared rays having a specific wavelength generated from active oxygen generated in the tissue during treatment. CONSTITUTION:At the time of treatment, the wavelength of the pulse laser beam from a laser beam source 8 is changed over to 630nm and the pulse laser beam having this wavelength irradiates the affected part C through a light guide 4 to perform the treatment of cancer due to photochemical reaction. Beam of 1.27mum is emitted from active singlet oxygen generated from the affected part C during the irradiation with beam of 630nm and guided to a spectroscope 9 through a light guide 5 to be diffracted by a diffraction lattice 32 and detected by a beam detector 42. As the beam detector 42, a germanium detector high in sensitivity at 1.27mum or, according to circumstances, a Ge beam detector under cooling due to a cooling medium, for example, liquid nitrogen, is used in order to enhance an S/N ratio. The output signal from the beam detector 42 is amplified by an amplifier 44 and the output thereof is read by an output meter 45. A gate circuit 43 accurately detects the beam of 1.27mum.

Description

Detailed Description of the Invention [Industrial Field of Application] The present invention provides hematoporphyrin derivatives (HemaLo-
Porphyrin Derivative, hereinafter H
Laser light is irradiated onto fluorescent substances such as pD, which tend to accumulate in cancer cells and have a cell-killing effect when excited by light, and the photochemical reaction between the fluorescent substance and the laser light is used to kill only cancer cells. Cancer treatment is possible by selectively causing necrosis of
Regarding cancer diagnosis and treatment equipment that diagnoses cancer by measuring the distribution and intensity of fluorescent light generated from fluorescent substances, in particular whether or not the treatment by photochemical reaction is being performed accurately during cancer treatment. The present invention relates to a cancer diagnosis and treatment device that can determine the amount of cancer and improve the reliability and functionality of the device.

[Conventional technology]

For diagnosis and treatment of cancer, a fluorescent substance with a strong affinity for cancer, such as HpD, is absorbed into the lesion area in advance, and when this area is irradiated with laser light, a photochemical reaction occurs between the fluorescent substance and the laser light. A cancer diagnosis and treatment method and apparatus have been proposed in which cancer cells are selectively necrotized using
No. 0830, JP-A-59-40869).

FIG. 6 is a diagram showing the basic configuration of the conventional diagnostic treatment apparatus proposed above, in which 1 is a tissue surface, 2 is an image guide, 3 to 5 are light guides, 6 is a color camera, 7 is a white light source, 8 is a laser light source, 9 is a spectroscope, 10 is a fluorescence spectrum image, 11 is a high-sensitivity camera, 12 is an analysis circuit, 13
．． 14 is a monitor, 15 is a fiber bundle, 16 is a video signal, 17 is an endoscopic diagnosis system, and 18 is a photochemical reaction diagnosis treatment system.

The apparatus shown in FIG. 6 can be divided into a normal endoscopic diagnosis system 17 and a photochemical reaction diagnosis treatment system 18. The fiber bundle 15 is incorporated into an endoscope and inserted into a site suspected of being a lesion in a patient who has previously been intravenously injected with HpD.

The endoscopic diagnosis system 17 includes a white light source for illuminating the tissue surface, a light guide 3 that guides this light, an image guide 2 that guides an image of the tissue surface 1 to a color camera 6, and a color camera that captures the image of the tissue surface 1. It consists of a monitor 13 on which the image obtained by photographing in step 6 is displayed.

On the other hand, on the 1st day of the photochemical reaction diagnosis and treatment system, diagnostic light (405 nm) for diagnosis and therapeutic light (630 nm) for treatment were used.
) is provided as a pulsed laser beam. These lights are guided to the affected area by the light guide 4 and irradiated thereon. Fluorescent light generated by irradiation with a diagnostic laser beam during diagnosis is guided to a spectrometer 9 by a light guide 5. A fluorescence spectrum image 10 obtained by the spectrometer 9 is photographed by a high-sensitivity camera 11, and this output video signal 16 is processed by an analysis circuit 12 to be graphically displayed and displayed on a monitor 14 as a spectrum waveform. Spectral image 10 is 630 nm characteristic of Hp D fluorescence.
-, 690n'', and in order to observe this spectrum, the spectroscopic wavelength range of the spectrometer 9 is 600 to 700n.
It is set to nm.

Since endoscopic diagnosis and photochemical reaction diagnosis treatment are performed concurrently, the white light source 7 and the laser light source 8 are time-shared to illuminate the tissue surface 1.
irradiate. The fluorescence spectrum analysis system from the spectrometer 9 to the monitor 14 also operates intermittently in synchronization with the laser beam irradiation.

With this device, the operator can simultaneously view the tissue image on the monitor 13 and the fluorescence spectrum waveform on the monitor 14 during diagnosis to locate the cancer, and if the cancer is discovered, the excitation light can be used for treatment. Treatment can be performed immediately by simply switching.

This treatment is performed by selectively necrotizing only the septum through a photochemical reaction between HpD remaining in the septum and therapeutic light. Furthermore, regarding confirmation of fluorescence during diagnosis,
Since the spectral waveform unique to fluorescence itself is directly observed, there is no confusion with autofluorescence from normal areas, making it easy to identify cancer. In particular, it has the potential to greatly contribute to the diagnosis and treatment of early-stage cancer.

The wavelength of the therapeutic light was set to 630 nm due to several H
This is because the absorption by blood is the lowest at this wavelength in the pD absorption band, so the laser light can reach deep into the Jl tissue and can be expected to treat deep cancers. Further, the wavelength of the diagnostic light was set to 405 nm because the absorption of HpD is large at this wavelength, and the fluorescent light unique to HpD can be efficiently generated.

[Problem that the invention seeks to solve]

As mentioned above, conventional cancer diagnosis and treatment devices perform diagnosis and treatment using the affinity of HpD for cancer, but in particular, in treatment, in addition to affinity, the cell-killing effect when photoexcited is Use it effectively.

As a principle of treatment, the following mechanism is generally considered to be correct. That is, tl pD is energetically excited by 630 nm wavelength light, and this energy is transferred to oxygen in cancer cells. Oxygen, which was initially in the ground state of energy, is excited and activated by the energy transferred from HpD. Cancer tissue is strongly affected by this oxygen activity and becomes necrotic. By this principle, HpD
The septum where a large amount of active oxygen accumulates is necrotic, and the influence of active oxygen can be virtually ignored in the normal area where there is little accumulation. As a result,
Treatment using photochemical reactions can destroy only the cancer without affecting normal tissue, so it can be said to be a safe and painless method for sellers.

Moreover, when HpD is administered to the human body, there are no side effects other than mild skin irritation when exposed to direct sunlight.
This treatment is becoming increasingly popular. However, at the same time, we are also experiencing new problems.

It uses the same dose of HpD for the same disease state,
Even if the laser irradiation conditions, i.e. wavelength, laser energy per pulse, pulse repetition, irradiation time, etc., are the same,
The problem is that the results of treatment are not always the same, and while the treatment may be effective for some patients, it may not be as effective for others. This is believed to be due to differences in the amount of HpD retained, the amount of oxygen, etc., depending on the patient, for example, between the young and the elderly. If it is not done 1-3 days after laser irradiation, the treatment effect will be 61! Being difficult to acknowledge is both inconvenient and anxiety-inducing. It is desirable that the outcome of treatment can be predicted with sufficient accuracy during laser irradiation.

The present invention is intended to solve the above-mentioned problems, and aims to provide a cancer diagnosis and treatment device that can predict the effects of treatment with sufficient accuracy.

[Means for solving problems]

The cancer diagnosis and treatment device of the present invention uses a substance that has an affinity for cancer cells and has a fluorescent or cell-killing effect when excited by light, and cells containing this substance are irradiated with a light source device. In devices that diagnose and treat cancer,
A spectroscope for separating the fluorescent light obtained by optically exciting the substance, an imaging means for converting the spectrum from the spectroscope into a video signal, and a photodetector that is notorious for the specific wavelength light from the spectroscope. and a display means for displaying the output from the imaging means or the photodetector, and at the time of diagnosis, the fluorescent light obtained by exciting the substance with the excitation light of the first wavelength is separated and a spectral image is displayed, and the treatment is performed. The principle of the present invention is characterized by spectroscopically detecting and displaying specific wavelength light emitted from active oxygen in cancer tissue by excitation with excitation light of a second wavelength. The purpose of this method is to monitor the treatment status by detecting infrared light of a specific wavelength (wavelength: 1.27 μm) generated from active oxygen generated in textiles. H
The process in which pD is excited by laser light and oxygen is activated by this energy is explained in the fourth section using an energy diagram.
This will be explained using figures.

When 630 nm wavelength laser light is irradiated on HpD, f■p
D is excited from the 80 state of energy to the SI state. The So and S+ states contain fine structural components of vibrational energy and rotational energy, creating a band-like energy distribution. The reason why laser light with a wavelength of 630 nm is used for treatment is that among the several HpD absorption bands, this wavelength has the lowest absorption by blood, so using this wavelength allows the laser light to reach deep into tissues. This is because it can be expected to treat deep cancer. S, state Hp D transfers energy to oxygen OX (triplet 30□ state) in the cell via another energetic state BT1. Oxygen is excited to the singlet state 10□ by this energy and becomes active. This active oxygen acts on cancer tissue and causes necrosis of cancer M1 tissue. In other words, cancer treatment becomes possible. 1.27μ
The infrared light of m is obtained as a result of relaxation from the level of vibrational quantum number v=Q with energy of 10□ forming a band shape to the level of vibrational quantum number v=Q with energy of jO□. That is 1.2
7μm light is the light generated by oxygen ('oz) in the active state.Therefore, if we detect this 1.27μm light and evaluate its intensity, we can estimate the number of 102 existing in proportion to this. . As a result, by measuring 1.27 μm light during laser beam irradiation treatment, it is possible to judge whether or not the phototherapy is being performed smoothly.

〔Example〕

The present invention will be explained below according to examples.

FIG. 1 is a configuration diagram of a portion of a cancer diagnosis and treatment device related to the present invention. The overall device is a development of the configuration shown in Figure 6, which is based on the 17th endoscopic diagnosis system and adds new functions to the 18th photochemical reaction diagnosis and treatment system. Therefore, FIG. 1 shows only the photochemical reaction diagnostic treatment system to which this new function of the present invention is added, and the same numbers as in FIG. 6 indicate the same contents. In the figure, C is the lesion area, 31
．． 33 is a reflecting mirror, 32 is a diffraction grating, 34 is a shutter, 3
5 is an image intensifier tube, 361 is a photocathode,
36g is a fluorescent surface, 37 is an imaging lens, 41 is an image intensifier tube driving circuit, 42 is a photodetector, 43 is a gate circuit, 44 is an amplifier, 45 is an output meter, and 47 is a timing control circuit.

At the time of diagnosis, an appropriate amount of HpD was injected intravenously in advance, and 4 05 n was generated from the laser light source 8 at the lesion C of the patient.
A pulsed laser beam of m wavelength is irradiated through the light guide 4. At this time, fluorescence is generated from the lesion C and is guided to the spectrometer 9 through the light guide 5. The fluorescent light emitted from the output end of the light guide 5 diverges, is reflected by the reflecting mirror 31, and enters the diffraction grating 32. The light separated by the diffraction grating 32 is imaged on the photocathode 361 of the image intensity 1 ear tube 35, and a spectral image of the fluorescent light is obtained at this position. Since the fluorescence spectrum is weak, it is multiplied by the image intensifier tube 35, and an image of the multiplied fluorescence spectrum is formed on the fluorescent screen 36□. The spectral image on the phosphor screen 362 is filtered by the high-sensitivity camera 11, and the output video signal 38 is subjected to signal processing by the analysis circuit 12 and then displayed as a waveform A on the TV monitor 14 as a spectrum. Here, the shutter 34 is provided to protect the photocathode 361 of the image intensifier tube 35 from strong light irradiation, and should not be used in an open state during diagnosis, since strong therapeutic laser light will enter during treatment. , used in closed state). The image intensifier tube drive circuit 41 supplies the voltage necessary to operate the image intensifier tube 35. f
It is X.

In the endoscopic diagnosis system, white light is irradiated to observe the lesion C, and this and 405 nm laser light are irradiated to the lesion C alternately in time. Since the white light reflected from the lesion C is strong, the operation of the image intensifier tube 35 is stopped by stopping the voltage supply to the image intensifier tube during white light irradiation. The imaging lens 37 is the fluorescent screen 3 of the image intensifier tube 35.
The spectral image on 6□ is captured on the photocathode 36 of the high-sensitivity camera 11. This is to form an image on top of the spectral image, thereby capturing a spectral image with low tQ loss.

If the spectral image obtained by the monitor 14 is unique to HpD, it can be seen that the lesion C contains HpD, and since HpD has a strong affinity for cancer, the lesion C seems to be cancerous. It is estimated to be.

FIG. 2 shows a timing chart of the apparatus of the present invention employed at the time of diagnosis.

In the figure, a pulse with a pulse width of 10 μs and a voltage of 5 V for triggering the laser beam 'a8 from the timing control circuit 47 has a repetition frequency of 60H2, thus 16.
It is issued every 7ms. About 1μs later than this, about 5n
A diagnostic laser beam having a width of s is generated. HpD fluorescence is obtained at approximately the same time as the laser beam. The white light pulse for observation of the lesion C is located at the middle of the repeated laser pulses, and is located at the second position in relation to the 1.27 μm light detection during treatment.
It is defined by the time conditions as shown in the figure. The image intensifier tube gate signal turns on the image intensifier tube only when detecting HpD fluorescence (B),
The image intensifier tube gate signal is sent from the timing control circuit 47 to the image intensifier tube drive circuit 41 to stop operation (OFF state B) to protect the image intensifier tube during white light pulse irradiation. The above 0N10FF operation is performed by the image intensifier tube drive circuit 41.

During treatment, the wavelength from the laser light source S is switched to 630 nm, and pulsed laser light of this wavelength is irradiated to the lesion C through the light guide 4. Through the process described above, 63
A photochemical reaction cancer treatment is performed between the HpD contained in the focal area C and the focal tissue using a 0 nm laser beam. This 630nm
Active heavy oxygen (IQ□
) emits 1.27 μm light. The 1.27 μm light is guided to the spectroscope 9 through the light guide 5, diffracted by the diffraction grating 32, and then detected by the photodetector 42. As the photodetector 42, a germanium (Ge) detector with a large diameter of 1.27 μm"i?9 degrees is used, and in some cases, a S/
To increase the N, a Ge photodetector under cooling with a cooling medium, for example liquid nitrogen, is used. The output signal from the photodetector 42 is amplified by an amplifier 44, and its output is read out by an output meter 45. The gate circuit 43 is for accurately detecting 1.27 μm light. That is, wavelength 1. 2
In addition to the relaxation light from 10□ mentioned above, there is also H for light around 7 μm.
There is strong infrared fluorescence from the pD or from the focal body. These are generated almost at the same time as the laser beam, whereas the relaxation light from IO
(Yusuke Kuroda: Basic research on laser photochemical therapy, Journal of the Japanese Society of Laser Medicine, 6 (4), p. 27
(1983)). Therefore, in order to accurately detect the 1.27 μm light emitted from IO□, it is necessary to set the gate time so that the photodetector operates only when the 1.27 μm light is emitted from IO2.

FIG. 3 shows a timing chart of the device during treatment. As in the case of diagnosis, the laser beam with a wavelength of 63 Qnm is generated approximately 1 μs later than the laser trigger.

Infrared fluorescence from the living tissue of HpD and lesion C is generated at approximately the same time as the laser beam. The gate of the photodetector 42 is turned ON at the time when infrared fluorescence emission ends, and turned OFF before the white light pulse is emitted. In Figure 3, 0 from the laser trigger.
An example is shown in which the switch turns on after 5 ms and lasts for 2 ms. However, since it is expected that the start time of emission of 1.27 μm light from 10□ will differ slightly depending on the target lesion C, it is desirable to be able to adjust this gate time variably depending on the target. It is necessary that the Day 1-ON time can be varied within a range that does not overlap with the white light pulse and the infrared fluorescence emission time. This is because when the emission time of the white light pulse overlaps with the emission time of the white light pulse, the resulting infrared fluorescence from the lesion C interferes with the detection of the 1.27 μm light from +Q. The 1.27 μm light from '0□ is detected within the gate time as shown in FIG.

The output meter 45 may be one that can read the average value of the 60 Hz optical signal, and may be, for example, an ammeter that displays an rms value. The output signal of the amplifier 44 is sent to the analysis circuit 12 through a path 46, where the signal is processed and its intensity can be displayed on the monitor 14 as shown in waveform B. In the figure, two monitors are used for diagnosis. , shows a method of displaying the spectrum obtained during treatment, but it is also possible to display the spectrum during diagnosis and treatment on one monitor by signal processing by the analysis circuit 12.

FIG. 5 is an example of the laser light source 8 shown in FIG. 1, and is a diagram showing an example of a pulsed light source that can be switched between diagnostic and therapeutic purposes. In FIG.
The part that generates the second laser light pulse of 405 nm, and the part surrounded by the broken line 23, is the part that generates the first laser light pulse of 405 nm.

The excimer laser 26 is commonly used by the second pulsed light source 24 and the first pulsed light 'tX23, and uses an ethanol solution of the dye Rhodamine 610 of the second pulsed light source 24 to emit light with a wavelength of 630 nm. Laser DL2
(630nm), the first H/L/S light? Wavelength 4 using toluene and ethanol solution of yX23 dye PBBO
The first dye laser DLI (
405 nm). L4, L5
is a focusing lens, Ml and M4 are semi-transparent mirrors, and M2 and M3 are total reflection mirrors. The switching section 25 has two openings 25a.
, 25b. It can be moved by manual operation, and the excimer laser 26 and aperture 25 are used during treatment.
a, an optical path of the lens L4 is formed to excite the dye laser DL2, and during diagnosis, an optical path of the excimer laser 26, the aperture 25b, and the lens L5 is formed to excite the dye laser DLL.

The oscillation wavelength of the excimer laser 26 is 308 nm, the pulse width is 30 ns, and the energy is variable from several mJ to 100 mJ.
It is caused to repeatedly oscillate at a frequency of 0 Hz or an integer fraction thereof.

〔Effect of the invention〕

As described above, according to the present invention, the following effects can be achieved.

■The reliability of photochemical reaction cancer treatment can be improved. 1.27μ indicating that treatment is being performed during phototherapy
Since the light intensity can be monitored, the reliability of phototherapy can be improved. What is the intensity of this 1.27 μm light at lesion C and HpD?
It is desirable to calibrate the 1.27 μm light intensity obtained from the device in advance according to each case, as it changes depending on parameters such as laser light intensity. If the obtained 1.27 μm light intensity is small, operations such as increasing the laser light energy or moving the light guide 4 through which the laser light passes closer to the lesion C to increase the laser light energy density on the tissue surface may be performed. This can be used to improve accurate treatment effects.

■It becomes possible to examine the limitations of photochemical reaction cancer treatment methods. The photochemical reaction cancer treatment method is based on the premise that HpD is present in the cancer. Although it is currently being demonstrated that HpD selectively accumulates in some representative types of cancer and can be used for phototherapy, Hl)D selectively accumulates in all cancers. Moreover, it is not clear whether HpD is uniformly accumulated within the cancer tissue. By using the device of the present invention, it becomes possible to study these problems, and it becomes possible to study ways to improve the reliability of photochemical reaction cancer treatment.

Even if HpD is sufficiently accumulated in cancer, irradiation with therapeutic laser light does not always provide sufficient treatment. This seems to be a problem that is probably related to the individuality of living organisms. Substances in the body, such as vitamin A1 and vitamin E, are 10□
known to reduce the number of molecules. Additionally, the amount of oxygen supplied differs between areas with high blood flow and areas with low blood flow.

In this way, the microscopic conditions differ depending on the individual living body, so it is expected that the therapeutic effect will be affected.The present invention solves such problems by improving the reliability of photochemical reaction cancer treatment. A value of 0 or more indicates a substance that has a strong affinity for cancer and has a cell-killing effect when photoexcited (
Although HpD has been specifically explained as a chemical (drug), the present invention is not limited to HpD (and can be applied to substances other than HpD, such as pheophobite co-metal phthalocyanine and chlorophylls). Similar to HpD, these substances have a high affinity for cancer, and when photoexcited, they cause cancer necrosis through the action of active oxygen (+Q, ) in cancer tissue.By relaxing '02, 1 .27
The generation of μm light is similar to HpD. However, since the absorption wavelength of these substances is different from that of HpD, it is also necessary to change the wavelength of the therapeutic laser beam.

[Brief explanation of the drawing]

FIG. 1 is a diagram showing the configuration of the photochemical reaction cancer diagnosis and treatment system of the device of the present invention, FIG. 2 is a diagram showing a timing chart of the device of the present invention during diagnosis, and FIG. 3 is a timing chart of the device of the present invention during treatment. Figure 4 shows the infrared 1 related to the present invention.
．． FIG. 5 is a diagram for explaining the process of emitting 27 μm light, FIG. 5 is a diagram showing an example of a pulsed laser light source, and FIG. 6 is a diagram showing the configuration of a conventional photochemical reaction cancer diagnosis and treatment device. ■... m-woven surface, 4.5 is a light guide, 8... laser light source, 9... spectrometer, 11... high sensitivity camera,
12... Analysis circuit, 14... Monitor, 32... Diffraction grating, 34... Shafter, 35... Image intensifier tube, 36. ...Photocathode, 36□...
Fluorescent surface, 37... Imaging lens, 41... Image intensifier tube drive circuit, 42... Photodetector, 4
3... Gate circuit, 47... Timing control circuit. Applicant Hamamatsu Photonics Co., Ltd. Representative
Person Patent Attorney Masaru Hirukawa Figure 2 Figure 3 Figure 4 pD Figure 5

Claims (8)

[Claims] (1) Diagnosis of cancer by using a substance that has an affinity for cancer cells and has a fluorescent or cell-killing effect when excited by light, and irradiating cells containing this substance with a light source device; A treatment device includes a spectroscope for separating fluorescence obtained by optically exciting the substance, an imaging means for converting the spectrum from the spectrometer into a video signal, and a device sensitive to light of a specific wavelength from the spectrometer. and a display means for displaying the output from the imaging means or the photodetector, and at the time of diagnosis, the fluorescent light obtained by exciting the substance with excitation light of the first wavelength is divided into spectra. 1. A cancer diagnosis and treatment device that displays an image and, during treatment, excites with excitation light of a second wavelength and spectrally detects and displays light of a specific wavelength emitted from active oxygen in cancer tissue. (2) The substance is a hematoporphyrin derivative (HpD)
The specific wavelength light is 1.27 μm light, the first wavelength excitation light that causes fluorescence emission is pulsed light with a wavelength of 405 nm, and the second wavelength excitation light emitted from active oxygen in cancer tissue is 630 nm wavelength. 2. The cancer diagnosis and treatment apparatus according to claim 1, wherein the pulsed light is: (3) The spectrometer includes an entrance part to which a light guide is attached that transmits light generated from the lesion, a reflector that folds back the light that has passed through the entrance part and reflects it in the direction of a diffraction grating, and spectrally spectrally spectra the incident light. 2. The cancer diagnosis and treatment apparatus according to claim 1, comprising a diffraction grating, an exit port for taking out the separated fluorescence spectrum, and an exit port for taking out the separated spectroscopic light of a specific wavelength. (4) The photodetector for detecting the specific wavelength light is 1.27
The cancer diagnosis and treatment device according to claim 1, which is a germanium detector sensitive to μm wavelength light and can be cooled with a cooling medium such as liquid nitrogen. (5) The system for displaying a spectral image of fluorescence at the time of diagnosis includes a shutter, an image intensifier tube, an imaging lens,
A high-sensitivity camera and an analysis circuit are arranged in this order, and the output video signal of the high-sensitivity camera is processed by the analysis circuit and then sent to the TV.
2. The cancer diagnosis and treatment apparatus according to claim 1, wherein a spectral image of fluorescent light is displayed on a monitor. (6) The cancer diagnosis and treatment apparatus according to claim 1, wherein the shutter is opened to allow light to pass through when diagnosing cancer, and closed to block the passage of light during cancer treatment. (7) In the system that spectrally detects and displays light of a specific wavelength during the treatment, a photodetector is attached to the exit port of the spectrometer for extracting light of a specific wavelength, and after amplifying the detector output, signal processing is performed in an analysis circuit. The cancer diagnosis and treatment apparatus according to claim 1, wherein the specific wavelength light is displayed on a TV monitor. (8) When the excitation light of the second wavelength is irradiated to the lesion, the photodetector starts photodetection after the emission of pulsed infrared fluorescence from the substance or the lesion tissue stops. 2. The cancer diagnosis and treatment apparatus according to claim 1, wherein the light detection is completed before the white light pulse used for observation of the lesion is emitted.