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Automated imaging cytometry reveals dysplastic indices of colonic serrated adenomas. Future Sci OA 2020; 6:FSO459. [PMID: 32257372 PMCID: PMC7117562 DOI: 10.2144/fsoa-2019-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Left-sided colonic serrated adenomas (L-SAs) were evaluated for aneuploidy using automated imaging cytometry to quantify DNA content and compared with normal colonic tissues (NCT), tubular adenomas (TA), left-sided hyperplastic polyps (L-HP) and adenocarcinomas. Materials & methods: We used standard paraffin-embedded Feulgen-stained tissue sections. Results: The mean DNA index (DI) of NCT was 0.95, L-HP was 1.08, TA was 1.22, L-SA was 1.11 and adenocarcinomas was 1.46. DI of L-SA was statistically higher than that of NCT, but not statistically different from L-HP. Conclusion: This study demonstrates that DIs correlate with the described neoplastic progression of L-SA, TA and L-SA compared with NCT and suggests that L-SA may be involved in a chromosome instability pathway of neoplastic progression. Colon cancer remains a deadly disease, with a significant burden of illness to patients and healthcare systems. While most precursor lesions will not necessarily produce cancers, they vary in histology and potential for neoplastic progression. Aneuploidy or abnormal chromosomal content of a cell is considered a marker for chromosomal instability and neoplastic progression. However, conventional methods of assessment can be laborious, costly and may even underestimate its malignant potential if the lesion is focal, small and surrounded by normal stromal cells in the sampled tissue. We used a nuclear stain to detect and quantify aneuploidy on conventionally prepared colonic precancerous histological slides and in particular assessed serrated and hyperplastic polyps of the left colon. When compared with normal tissues, we determined that there was aneuploidy in these lesions, which supports the underappreciated assumption that these lesions manifest chromosomal instability.
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Mascagni P, Longo F, Barberio M, Seeliger B, Agnus V, Saccomandi P, Hostettler A, Marescaux J, Diana M. New intraoperative imaging technologies: Innovating the surgeon’s eye toward surgical precision. J Surg Oncol 2018; 118:265-282. [DOI: 10.1002/jso.25148] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/04/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Pietro Mascagni
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Fabio Longo
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Manuel Barberio
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Barbara Seeliger
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Vincent Agnus
- IRCAD, Research Institute against Digestive Cancer; Strasbourg France
| | - Paola Saccomandi
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | | | - Jacques Marescaux
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
- IRCAD, Research Institute against Digestive Cancer; Strasbourg France
| | - Michele Diana
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
- IRCAD, Research Institute against Digestive Cancer; Strasbourg France
- Department of General, Digestive and Endocrine Surgery; University of Strasbourg; Strasbourg France
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Qiu L, Chuttani R, Pleskow DK, Turzhitsky V, Khan U, Zakharov YN, Zhang L, Berzin TM, Yee EU, Sawhney MS, Li Y, Vitkin E, Goldsmith JD, Itzkan I, Perelman LT. Multispectral light scattering endoscopic imaging of esophageal precancer. LIGHT, SCIENCE & APPLICATIONS 2018; 7:17174. [PMID: 30839534 PMCID: PMC6060057 DOI: 10.1038/lsa.2017.174] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 05/14/2023]
Abstract
Esophageal adenocarcinoma is the most rapidly growing cancer in America. Although the prognosis after diagnosis is unfavorable, the chance of a successful outcome increases tremendously if detected early while the lesion is still dysplastic. Unfortunately, the present standard-of-care, endoscopic surveillance, has major limitations, since dysplasia is invisible, often focal, and systematic biopsies typically sample less than one percent of the esophageal lining and therefore easily miss malignancies. To solve this problem we developed a multispectral light scattering endoscopic imaging system. It surveys the entire esophageal lining and accurately detects subcellular dysplastic changes. The system combines light scattering spectroscopy, which detects and identifies invisible dysplastic sites by analyzing light scattered from epithelial cells, with rapid scanning of the entire esophageal lining using a collimated broadband light beam delivered by an endoscopically compatible fiber optic probe. Here we report the results of the first comprehensive multispectral imaging study, conducted as part of routine endoscopic procedures performed on patients with suspected dysplasia. In a double-blind study that characterized the system's ability to serve as a screening tool, 55 out of 57 patients were diagnosed correctly. In addition, a smaller double-blind comparison of the multispectral data in 24 patients with subsequent pathology at locations where 411 biopsies were collected yielded an accuracy of 90% in detecting individual locations of dysplasia, demonstrating the capability of this method to serve as a guide for biopsy.
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Affiliation(s)
- Le Qiu
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Ram Chuttani
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Douglas K Pleskow
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Vladimir Turzhitsky
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Umar Khan
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Yuri N Zakharov
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Lei Zhang
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Tyler M Berzin
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Eric U Yee
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Mandeep S Sawhney
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Yunping Li
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Edward Vitkin
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Jeffrey D Goldsmith
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Irving Itzkan
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
| | - Lev T Perelman
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA
- Biological and Biomedical Sciences Program, Harvard University, Boston, MA 02215, USA
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4
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Diana M, Robinet E, Liu YY, Legnèr A, Kong SH, Schiraldi L, Marchegiani F, Halvax P, Swanstrom L, Dallemagne B, Marescaux J. Confocal Imaging and Tissue-Specific Fluorescent Probes for Real-Time In Vivo Immunohistochemistry. Proof of the Concept in a Gastric Lymph Node Metastasis Model. Ann Surg Oncol 2015; 23:567-573. [DOI: 10.1245/s10434-015-4928-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Indexed: 12/23/2022]
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Supportive automatic annotation of early esophageal cancer using local gabor and color features. Neurocomputing 2014. [DOI: 10.1016/j.neucom.2014.02.066] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Song J, Zhang J, Wang J, Guo X, Yu S, Wang J, Liu Y, Dong W. Meta-analysis of the effects of endoscopy with narrow band imaging in detecting dysplasia in Barrett's esophagus. Dis Esophagus 2014; 28:560-6. [PMID: 24758693 DOI: 10.1111/dote.12222] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Narrow band imaging (NBI) is a real-time imaging technique. The aim of this meta-analysis was to estimate the sensitivity, specificity, and diagnostic accuracy on the role of NBI in the detection and characterization of specialized intestinal metaplasia (SIM), high-grade dysplasia (HGD) in the Barrett's esophagus. We identified studies by performing a literature search of Medline, EMBASE, and the Cochrane Library databases up to May 2013. We performed data analysis using Meta-DiSc (version 1.4) software. To assess study quality and potential for bias, we used the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). Overall, seven eligible studies including over 3988 lesions of 502 patients were retrieved. The results showed that endoscopic diagnosis of dysplasia performed using NBI has a high diagnostic performance, with an area under the summary receiver operating characteristic (SROC) curve near 0.90 both in HGD lesions and SIM lesions. We also found that NBI has a sensitive and specificity of 0.91 (95% confidence interval [CI] = 0.86-0.94) and 0.85 (95% CI = 0.76-0.92) on a per-patient element, and 0.97 (95% CI = 0.95-0.98) and 0.64 (95% CI = 0.59-0.68) on a per-lesion element for SIM diagnosis, respectively. The pooled per-patient sensitivity and specificity for identifying HGD are 0.91 (95% CI = 0.75-0.98) and 0.95 (95% CI = 0.91-0.97). The pooled per-lesion sensitivity and specificity for identifying HGD are 0.69 (95% CI = 0.63-0.74) and 0.90 (95% CI = 0.88-0.91). In conclusion, we found that endoscopic diagnosis with NBI is an accurate test to diagnosis dysplasia of Barrett's esophagus.
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Affiliation(s)
- J Song
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - J Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - J Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - X Guo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - S Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - J Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Y Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - W Dong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Espino A, Cirocco M, Dacosta R, Marcon N. Advanced imaging technologies for the detection of dysplasia and early cancer in barrett esophagus. Clin Endosc 2014; 47:47-54. [PMID: 24570883 PMCID: PMC3928491 DOI: 10.5946/ce.2014.47.1.47] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 12/30/2013] [Accepted: 12/30/2013] [Indexed: 12/14/2022] Open
Abstract
Advanced esophageal adenocarcinomas arising from Barrett esophagus (BE) are tumors with an increasing incidence and poor prognosis. The aim of endoscopic surveillance of BE is to detect dysplasia, particularly high-grade dysplasia and intramucosal cancers that can subsequently be treated endoscopically before progression to invasive cancer with lymph node metastases. Current surveillance practice standards require the collection of random 4-quadrant biopsy specimens over every 1 to 2 cm of BE (Seattle protocol) to detect dysplasia with the assistance of white light endoscopy, in addition to performing targeted biopsies of recognizable lesions. This approach is labor-intensive but should currently be considered state of the art. Chromoendoscopy, virtual chromoendoscopy (e.g., narrow band imaging), and confocal laser endomicroscopy, in addition to high-definition standard endoscopy, might increase the diagnostic yield for the detection of dysplastic lesions. Until these modalities have been demonstrated to enhance efficiency or cost effectiveness, the standard protocol will remain careful examination using conventional off the shelf high-resolution endoscopes, combined with as longer inspection time which is associated with increased detection of dysplasia.
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Affiliation(s)
- Alberto Espino
- Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Maria Cirocco
- Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Ralph Dacosta
- Department of Medical Biophysics, Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Norman Marcon
- Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, ON, Canada
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Diagnostic accuracy of probe-based confocal laser endomicroscopy and narrow band imaging in detection of dysplasia in duodenal polyps. J Clin Gastroenterol 2012; 46:382-9. [PMID: 22499072 DOI: 10.1097/mcg.0b013e318247f375] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
GOALS To estimate the accuracy of probe-based confocal laser endomicroscopy (pCLE) and narrow band imaging (NBI), individually and in combination, for classification of duodenal polyps. BACKGROUND Ex vivo pathologic diagnosis of duodenal polyps causes time delay, requiring separate procedures for diagnosis and therapy. It also involves small risk of pancreatitis in ampullary adenomas and can make subsequent endoscopic mucosal resection more difficult by "tacking down" mucosa. In vivo diagnosis with pCLE and NBI may avoid these complications and may guide immediate therapy. STUDY During high-definition white light endoscopy, 1 endoscopist (M.B.W.) performed NBI and then, pCLE of duodenal sites. Matched tissue sampling or endoscopic mucosal resection was performed. Confocal videos were recorded, de-identified, and reviewed by same endoscopist, blinded to histopathology, 1 month later. Confocal features of dysplasia in Barrett esophagus were applied for detection of duodenal dysplasia. RESULTS Of 65 sites from 36 participants, 24 lesions showed dysplasia, whereas 41 polyps and control sites were nondysplastic on histopathology, used as standard reference. The accuracy, sensitivity, and specificity of pCLE were 83%, 92%, and 78%, whereas that of NBI were 80%, 83%, and 78%, respectively. In subset of 49 lesions with similar pCLE and NBI diagnosis, the accuracy, sensitivity, and specificity, improved significantly and was found to be 92%, 95%, and 90%, respectively. CONCLUSIONS Our study suggests that pCLE has superior sensitivity as compared with NBI for detection of dysplasia in duodenal polyps. Combined accuracy of pCLE and NBI approaches that of ex vivo pathology, which may help in avoiding biopsy sampling.
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Doherty GA, Cheriyan DG, Leyden JE, O'Dowd JF, Murray FE, Patchett SE. Inter-endoscopist agreement in diagnosis of Barrett's oesophagus. Frontline Gastroenterol 2011; 2:162-167. [PMID: 28839603 PMCID: PMC5536829 DOI: 10.1136/fg.2010.001529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2010] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To assess how interpretation of abnormalities at the oesophago-gastric junction (OGJ) when making a diagnosis of Barrett's oesophagus (BO) varies between endoscopists and to examine the impact of the endoscopy experience on these decisions. DESIGN/SETTING Members of the Irish Society of Gastroenterology who regularly perform gastroscopy were invited to participate in a web based image assessment study. INTERVENTIONS Questions were posed to ascertain level of endoscopy experience, and participants were asked to indicate the presence or absence of BO in 12 endoscopic images of the OGJ. OUTCOME MEASURES Primary outcome was overall level of agreement in responses and relationship to endoscopy experience. RESULTS The responses of 65 clinicians regularly performing gastroscopy were analysed. In 3/12 images, showing typical long segment BO, there was a strong consensus on the endoscopic diagnosis (>95% agreement). However, agreement was fair to poor (κ for multiple raters, 0.31) on the presence or absence of short BO segments at endoscopy. Minimal differences were observed between experienced endoscopists (individuals with >10 years' endoscopy experience) and less experienced counterparts in the threshold for BO diagnosis. Inter-endoscopist agreement overall was not significantly better within the more experienced group. CONCLUSION The study demonstrates low interobserver agreement in endoscopic diagnosis of (short segment) BO, even among experienced endoscopists. Given the costs associated with endoscopic surveillance of BO, prompt efforts to promote consensus diagnosis and improve agreement are required as an important quality improvement measure in this area.
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Affiliation(s)
- Glen A Doherty
- Department of Gastroenterology, Beaumont Hospital/Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Danny G Cheriyan
- Department of Gastroenterology, Beaumont Hospital/Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jan E Leyden
- Department of Gastroenterology, Beaumont Hospital/Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John F O'Dowd
- Department of Pathology, Bon Secours Hospital/Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank E Murray
- Department of Gastroenterology, Beaumont Hospital/Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen E Patchett
- Department of Gastroenterology, Beaumont Hospital/Royal College of Surgeons in Ireland, Dublin, Ireland
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Rey JF, Lambert R, Aabakken L, Dekker E, East JE, Kaltenbach T, Kato M, Sharma P, Tanaka S. Proceedings of a preliminary workshop at Gastro 2009--narrow banding imaging in digestive endoscopy: clinical outcome of classification (Omed-Jges Educational Meeting held on 22 November, 2009). Dig Endosc 2011; 23:251-66. [PMID: 21699571 DOI: 10.1111/j.1443-1661.2010.01083.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This publication reports the proceedings of the preliminary meeting of the working party that met at Gastro 2009 during the World Congress in London. The purpose of the preliminary meeting was to consider the areas that require attention, to discuss some of the findings that have already been published and to agree on the way forward. Our reason for publishing these proceedings is to stimulate interest in this venture and to provide the opportunity for input from the endoscopy community worldwide. The next meeting of the working party will be at the JGES Society meeting in Aomori in April 2011 when we hope to prepare a preliminary classification. This will be presented for general discussion and debate at the International Congress of Endoscopy (ICE) in Los Angeles in September 2011.
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Affiliation(s)
- Jean-Francois Rey
- Department of Hepatology and Gastroenterology, Institut Arnault Tzanck, Saint Laurent du Var, Lyon, France.
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Kara MA, Curvers W, Bergman J. Advanced endoscopic imaging in Barrett's esophagus. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2010. [DOI: 10.1016/j.tgie.2010.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Multifocal neoplasia and nodal metastases in T1 esophageal carcinoma: implications for endoscopic treatment. Ann Surg 2010; 251:186-7. [PMID: 19935402 DOI: 10.1097/sla.0b013e3181c76a66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Advancements in endoscopic imaging for the detection of esophageal dysplasia and carcinoma. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2010. [DOI: 10.1016/j.tgie.2010.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Shahid MW, Wallace MB. Endoscopic imaging for the detection of esophageal dysplasia and carcinoma. Gastrointest Endosc Clin N Am 2010; 20:11-24, v. [PMID: 19951791 DOI: 10.1016/j.giec.2009.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Numerous endoscopic imaging modalities have been developed and introduced into clinical practice to enhance diagnostic capabilities. In the past, detection of dysplasia and carcinoma of the esophagus has been dependent on biopsies taken during standard white-light endoscopy. Recent important developments in biophonotics have improved visualization of these subtle lesions sufficiently for cellular details to be seen in vivo during endoscopy. These improvements allow diagnosis to be made in gastrointestinal endoscopy units, thereby avoiding the cost, risk, and time delay involved in tissue biopsy and resection. Chromoendoscopy, narrow-band imaging, high-yield white-light endoscopy, Fujinon intelligent color enhancement, and point enhancement such as confocal laser endomicroscopy are examples of enhanced imaging technologies that are being used in daily practice. This article reviews endoscopic-based imaging techniques for the detection of esophageal dysplasia and carcinoma from the perspective of routine clinical practice.
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Affiliation(s)
- Muhammad W Shahid
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA
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Abstract
There have been many developments in endoscopy-based imaging for the detection of Barrett's syndrome, dysplasia, and neoplasia in patients with Barrett's esophagus. This article reviews the studies on and compares the efficacy of several important endoscopic imaging modalities. Some of these technologies have already achieved regulatory approval, commercial availability, and establishment of clinical utility and practical application. The future of imaging for Barrett's syndrome likely rests with the development of molecular targeting with dysplasiatargeted probes that have been conjugated to dyes or nanoparticles.
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Michalak J, Bansal A, Sharma P. Screening and surveillance of Barrett's esophagus. Curr Gastroenterol Rep 2009; 11:195-201. [PMID: 19463219 DOI: 10.1007/s11894-009-0031-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Esophageal adenocarcinoma (EAC) is the most rapidly increasing cancer in the Western world and Barrett's esophagus (BE) is the only known precursor lesion for this lethal cancer. Long-term survival may be improved if EAC is diagnosed early, providing an opportunity for early intervention. Screening for BE in patients with gastroesophageal reflux disease is not routinely recommended; however, if diagnosed, enrollment into a surveillance program may be beneficial. Surveillance of all patients with known BE is probably not cost-effective and factors predictive of BE progression to dysplasia/EAC are poorly understood. Screening and surveillance examinations are also faced with challenges in the endoscopic detection of intestinal metaplasia and dysplasia. Future application of molecular biomarkers may help identify the patients with BE most likely to progress, and the use of novel imaging methods may improve outcomes of BE screening and surveillance.
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Affiliation(s)
- Jeff Michalak
- University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, MO 64128, USA
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Kantsevoy SV, Adler DG, Conway JD, Diehl DL, Farraye FA, Kaul V, Kethu SR, Kwon RS, Mamula P, Rodriguez SA, Tierney WM. Confocal laser endomicroscopy. Gastrointest Endosc 2009; 70:197-200. [PMID: 19559426 DOI: 10.1016/j.gie.2009.04.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 04/03/2009] [Indexed: 12/11/2022]
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Curvers WL, van den Broek FJC, Reitsma JB, Dekker E, Bergman JJGHM. Systematic review of narrow-band imaging for the detection and differentiation of abnormalities in the esophagus and stomach (with video). Gastrointest Endosc 2009; 69:307-17. [PMID: 19185690 DOI: 10.1016/j.gie.2008.09.048] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 09/23/2008] [Indexed: 02/08/2023]
Affiliation(s)
- Wouter L Curvers
- Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
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Wolfsen HC, Crook JE, Krishna M, Achem SR, Devault KR, Bouras EP, Loeb DS, Stark ME, Woodward TA, Hemminger LL, Cayer FK, Wallace MB. Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett's Esophagus. Gastroenterology 2008; 135:24-31. [PMID: 18442484 DOI: 10.1053/j.gastro.2008.03.019] [Citation(s) in RCA: 226] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 02/25/2008] [Accepted: 03/13/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS High-resolution endoscopy with narrow band imaging (NBI) enhances the visualization of mucosal glandular and vascular structures. This study assessed whether narrow band targeted biopsies could detect advanced dysplasia using fewer biopsy samples compared with standard resolution endoscopy. METHODS We conducted a prospective, blinded, tandem endoscopy study in a tertiary care center with 65 patients with Barrett's esophagus undergoing evaluation for previously detected dysplasia. Standard resolution endoscopy was used first to detect visible lesions. Narrow band endoscopy was then used by another gastroenterologist to detect and biopsy areas suspicious for dysplasia. The lesions initially detected by standard resolution endoscopy were then disclosed and biopsied, after biopsy of the lesions targeted with NBI. Finally, random 4-quadrant biopsies were taken throughout the segment of Barrett's mucosa. RESULTS Higher grades of dysplasia were found by NBI in 12 patients (18%), compared with no cases (0%) in whom standard resolution white light endoscopy with random biopsy detected a higher grade of histology (P < .001). Correspondingly, narrow band directed biopsies detected dysplasia in more patients (n = 37; 57%) compared with biopsies taken using standard resolution endoscopy (n = 28; 43%). In addition, more biopsies were taken using standard resolution endoscopy with random biopsy compared with narrow band targeted biopsies (mean 8.5 versus 4.7; P < .001). CONCLUSIONS In patients evaluated for Barrett's esophagus with dysplasia, NBI detected significantly more patients with dysplasia and higher grades of dysplasia with fewer biopsy samples compared with standard resolution endoscopy.
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Affiliation(s)
- Herbert C Wolfsen
- Division of Gastroenterology, Laboratory Medicine and Biostatistics Unit, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
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Wolfsen HC, Wallace MB. Reconsidering Barrett's esophagus: practical applications of biophotonics. Gastroenterology 2008; 134:382-5. [PMID: 18242204 DOI: 10.1053/j.gastro.2007.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Herbert C Wolfsen
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Ginsberg GG. Seeing the light: enhanced endoscopic imaging to glimpse the Holy Grail. Gastrointest Endosc 2006; 64:193-4. [PMID: 16860067 DOI: 10.1016/j.gie.2006.03.917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Accepted: 03/30/2006] [Indexed: 12/18/2022]
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