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Park HC, Li D, Liang R, Adrales G, Li X. Multifunctional Ablative Gastrointestinal Imaging Capsule (MAGIC) for Esophagus Surveillance and Interventions. BME FRONTIERS 2024; 5:0041. [PMID: 38577399 PMCID: PMC10993155 DOI: 10.34133/bmef.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Objective and Impact Statement: A clinically viable technology for comprehensive esophagus surveillance and potential treatment is lacking. Here, we report a novel multifunctional ablative gastrointestinal imaging capsule (MAGIC) technology platform to address this clinical need. The MAGIC technology could also facilitate the clinical translation and adoption of the tethered capsule endomicroscopy (TCE) technology. Introduction: Recently developed optical coherence tomography (OCT) TCE technologies have shown a promising potential for surveillance of Barrett's esophagus and esophageal cancer in awake patients without the need for sedation. However, it remains challenging with the current TCE technology for detecting early lesions and clinical adoption due to its suboptimal resolution, imaging contrast, and lack of visual guidance during imaging. Methods: Our technology reported here integrates dual-wavelength OCT imaging (operating at 800 and 1300 nm), an ultracompact endoscope camera, and an ablation laser, aiming to enable comprehensive surveillance, guidance, and potential ablative treatment of the esophagus. Results: The MAGIC has been successfully developed with its multimodality imaging and ablation capabilities demonstrated by imaging swine esophagus ex vivo and in vivo. The 800-nm OCT imaging offers exceptional resolution and contrast for the superficial layers, well suited for detecting subtle changes associated with early neoplasia. The 1300-nm OCT imaging provides deeper penetration, essential for assessing lesion invasion. The built-in miniature camera affords a conventional endoscopic view for assisting capsule deployment and laser ablation. Conclusion: By offering complementary and clinically viable functions in a single device, the reported technology represents an effective solution for endoscopic screening, diagnosis, and potential ablation treatment of the esophagus of a patient in an office setting.
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Affiliation(s)
- Hyeon-Cheol Park
- Department of Biomedical Engineering,
Johns Hopkins University, Baltimore, MD 21205, USA
| | - Dawei Li
- Department of Biomedical Engineering,
Johns Hopkins University, Baltimore, MD 21205, USA
- Department of College of Future Technology,
Peking University, Beijing, 100871, China
| | - Rongguang Liang
- College of Optical Sciences,
University of Arizona, Tucson, AZ 85721, USA
| | - Gina Adrales
- Department of Surgery,
Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Xingde Li
- Department of Biomedical Engineering,
Johns Hopkins University, Baltimore, MD 21205, USA
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2
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Tuniyazi A, Mu T, Jiang X, Han F, Li H, Li Q, Gong H, Wang W, Qin B. Snapshot polarized light scattering spectroscopy using spectrally-modulated polarimetry for early gastric cancer detection. JOURNAL OF BIOPHOTONICS 2021; 14:e202100140. [PMID: 34089571 DOI: 10.1002/jbio.202100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 06/12/2023]
Abstract
Polarized light scattering spectroscopy (PLSS) is a promising optical technique developed for the detection of cancer, which extracts the single scattering light to infer morphological information of epithelial cells. However, traditional PLSS uses either a rotatable polarizer or two orthogonal polarizers to purify the single scattering light, which makes it complicated and challenged to build a PLSS endoscope. Herein, we propose a snapshot PLSS with a single optical path to directly get the single scattering light for the first time. The single scattering light is encoded using the spectrally-modulated polarimetry and decoded using the continuous slide iterative method. Both the polystyrene microsphere solutions and the ex vivo gastric cancer samples are used to verify the method. The experimental results of the snapshot PLSS are consistent well with that of the traditional PLSS. The proposed method has a potential for the building of snapshot PLSS endoscope systems in future.
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Affiliation(s)
- Abudusalamu Tuniyazi
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Tingkui Mu
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Xiaosa Jiang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Feng Han
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Haoyang Li
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Qiuxia Li
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Hang Gong
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Wenjing Wang
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Bin Qin
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Gupta N, Yelamanchi R, Agrawal H, Agarwal N. Role of optical coherence tomography in Barrett’s esophagus. Artif Intell Gastrointest Endosc 2021; 2:149-156. [DOI: 10.37126/aige.v2.i4.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/20/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
Traditional endoscopic techniques for Barrett’s esophagus (BE) surveillance relied on factor of probability as endoscopists performed cumbersome random biopsies of low yield. Optical coherence tomography (OCT) is a novel technique based on tissue light interference and is set to break conventional barriers. OCT was initially introduced in ophthalmology but was soon adopted by other areas of medicine. When applied to endoscopy, OCT can render images of the superficial layers of the gastrointestinal tract and is highly sensitive in detecting dysplasia in BE. Volumetric laser endomicroscopy is a second generation OCT endoscope device which is able to identify buried glands after ablation. Addition of artificial intelligence to OCT has rendered it more productive. The newer additions to OCT such as angiogram and laser marking will increase the accuracy of investigation. In spite of the few inevitable drawbacks associated with the technology, it presently outperforms all newer endoscopic techniques for the surveillance of BE.
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Affiliation(s)
- Nikhil Gupta
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi 110001, India
| | - Raghav Yelamanchi
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi 110001, India
| | - Himanshu Agrawal
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi 110001, India
| | - Nitin Agarwal
- Department of Surgical Disciploines, Postgraduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, Delhi 110001, India
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4
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Abstract
Endoscopic eradication therapy (EET) with maximal acid suppression is the cornerstone for the management of patients with Barrett's esophagus (BE) associated dysplasia. The occurrence of buried dysplastic glands after re-epithelialization of a neo-squamous epithelium is of concern for endoscopists. Here, we present a patient with BE and high-grade dysplasia successfully treated by EET who developed buried dysplastic BE during surveillance. A review of literature on buried dysplasia after successful endoscopic therapy of BE is also discussed.
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Affiliation(s)
- Prabhat Kumar
- Department of Gastroenterology, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ilyssa O Gordon
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Prashanthi N Thota
- Department of Gastroenterology, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Kiseleva E, Ryabkov M, Baleev M, Bederina E, Shilyagin P, Moiseev A, Beschastnov V, Romanov I, Gelikonov G, Gladkova N. Prospects of Intraoperative Multimodal OCT Application in Patients with Acute Mesenteric Ischemia. Diagnostics (Basel) 2021; 11:705. [PMID: 33920827 PMCID: PMC8071199 DOI: 10.3390/diagnostics11040705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Despite the introduction of increasingly multifaceted diagnostic techniques and the general advances in emergency abdominal and vascular surgery, the outcome of treatment of patients with acute impaired intestinal circulation remains unsatisfactory. The non-invasive and high-resolution technique of optical coherence tomography (OCT) can be used intraoperatively to assess intestine viability and associated conditions that frequently emerge under conditions of impaired blood circulation. This study aims to demonstrate the effectiveness of multimodal (MM) OCT for intraoperative diagnostics of both the microstructure (cross-polarization OCT mode) and microcirculation (OCT angiography mode) of the small intestine wall in patients with acute mesenteric ischemia (AMI). METHODS AND PARTICIPANTS A total of 18 patients were enrolled in the study. Nine of them suffered from AMI in segments II-III of the superior mesenteric artery (AMI group), whereby the ischemic segments of the intestine were examined. Nine others were operated on for adenocarcinoma of the colon (control group), thus allowing areas of their normal small intestine to be examined for comparison. Data on the microstructure and microcirculation in the walls of the small intestine were obtained intraoperatively from the side of the serous membrane using the MM OCT system (IAP RAS, Russia) before bowel resection. The MM OCT data were compared with the results of histological examination. RESULTS The study finds that MM OCT visualized the damage to serosa, muscularis externa, and blood vessels localized in these layers in 100% of AMI cases. It also visualized the submucosa in 33.3% of AMI cases. The MM OCT images of non-ischemic (control group), viable ischemic, and necrotic small intestines (AMI group) differed significantly across stratification of the distinguishable layers, the severity of intermuscular fluid accumulations, and the type and density of the vasculature. CONCLUSION The MM OCT diagnostic procedure optimally meets the requirements of emergency surgery. Data on the microstructure and microcirculation of the intestinal wall can be obtained simultaneously in real time without requiring contrast agent injections. The depth of visualization of the intestinal wall from the side of the serous membrane is sufficient to assess the volume of the affected tissues. However, the methodology for obtaining MM OCT data needs to be improved to minimize the motion artefacts generated in actual clinical conditions.
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Affiliation(s)
- Elena Kiseleva
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia;
| | - Maxim Ryabkov
- Thermal Injury Group, University Clinic, Privolzhsky Research Medical University, 18/1 Verkhnevolzhskaya Naberezhnaja, 603155 Nizhny Novgorod, Russia;
| | - Mikhail Baleev
- City Clinical Hospital No.30, 85A Berezovskaya St., 605157 Nizhny Novgorod, Russia; (M.B.); (V.B.); (I.R.)
| | - Evgeniya Bederina
- The Department of Pathology, University Clinic, Privolzhsky Research Medical University, 18/1 Verkhnevolzhskaya Naberezhnaja, 603155 Nizhny Novgorod, Russia;
| | - Pavel Shilyagin
- Institute of Applied Physics of the RAS, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (P.S.); (A.M.); (G.G.)
| | - Alexander Moiseev
- Institute of Applied Physics of the RAS, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (P.S.); (A.M.); (G.G.)
| | - Vladimir Beschastnov
- City Clinical Hospital No.30, 85A Berezovskaya St., 605157 Nizhny Novgorod, Russia; (M.B.); (V.B.); (I.R.)
| | - Ivan Romanov
- City Clinical Hospital No.30, 85A Berezovskaya St., 605157 Nizhny Novgorod, Russia; (M.B.); (V.B.); (I.R.)
| | - Grigory Gelikonov
- Institute of Applied Physics of the RAS, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (P.S.); (A.M.); (G.G.)
| | - Natalia Gladkova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia;
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He Z, Wang P, Ye X. Novel endoscopic optical diagnostic technologies in medical trial research: recent advancements and future prospects. Biomed Eng Online 2021; 20:5. [PMID: 33407477 PMCID: PMC7789310 DOI: 10.1186/s12938-020-00845-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022] Open
Abstract
Novel endoscopic biophotonic diagnostic technologies have the potential to non-invasively detect the interior of a hollow organ or cavity of the human body with subcellular resolution or to obtain biochemical information about tissue in real time. With the capability to visualize or analyze the diagnostic target in vivo, these techniques gradually developed as potential candidates to challenge histopathology which remains the gold standard for diagnosis. Consequently, many innovative endoscopic diagnostic techniques have succeeded in detection, characterization, and confirmation: the three critical steps for routine endoscopic diagnosis. In this review, we mainly summarize researches on emerging endoscopic optical diagnostic techniques, with emphasis on recent advances. We also introduce the fundamental principles and the development of those techniques and compare their characteristics. Especially, we shed light on the merit of novel endoscopic imaging technologies in medical research. For example, hyperspectral imaging and Raman spectroscopy provide direct molecular information, while optical coherence tomography and multi-photo endomicroscopy offer a more extensive detection range and excellent spatial-temporal resolution. Furthermore, we summarize the unexplored application fields of these endoscopic optical techniques in major hospital departments for biomedical researchers. Finally, we provide a brief overview of the future perspectives, as well as bottlenecks of those endoscopic optical diagnostic technologies. We believe all these efforts will enrich the diagnostic toolbox for endoscopists, enhance diagnostic efficiency, and reduce the rate of missed diagnosis and misdiagnosis.
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Affiliation(s)
- Zhongyu He
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China
| | - Peng Wang
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China
| | - Xuesong Ye
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China.
- State Key Laboratory of CAD and CG, Zhejiang University, Hangzhou, 310058, People's Republic of China.
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7
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Nie Z, Yeh SCA, LePalud M, Badr F, Tse F, Armstrong D, Liu LWC, Deen MJ, Fang Q. Optical Biopsy of the Upper GI Tract Using Fluorescence Lifetime and Spectra. Front Physiol 2020; 11:339. [PMID: 32477151 PMCID: PMC7237753 DOI: 10.3389/fphys.2020.00339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Screening and surveillance for gastrointestinal (GI) cancers by endoscope guided biopsy is invasive, time consuming, and has the potential for sampling error. Tissue endogenous fluorescence spectra contain biochemical and physiological information, which may enable real-time, objective diagnosis. We first briefly reviewed optical biopsy modalities for GI cancer diagnosis with a focus on fluorescence-based techniques. In an ex vivo pilot clinical study, we measured fluorescence spectra and lifetime on fresh biopsy specimens obtained during routine upper GI screening procedures. Our results demonstrated the feasibility of rapid acquisition of time-resolved fluorescence (TRF) spectra from fresh GI mucosal specimens. We also identified spectroscopic signatures that can differentiate between normal mucosal samples obtained from the esophagus, stomach, and duodenum.
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Affiliation(s)
- Zhaojun Nie
- School of Biomedical Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Shu-Chi Allison Yeh
- Advanced Microscopy Program, Center for Systems Biology and Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Michelle LePalud
- School of Biomedical Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Fares Badr
- School of Biomedical Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Frances Tse
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David Armstrong
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Louis W. C. Liu
- Division of Gastrointestinal Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M. Jamal Deen
- School of Biomedical Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Qiyin Fang
- School of Biomedical Engineering, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
- Department of Engineering Physics, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
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Ashrafi M, Xu Y, Muhamadali H, White I, Wilkinson M, Hollywood K, Baguneid M, Goodacre R, Bayat A. A microbiome and metabolomic signature of phases of cutaneous healing identified by profiling sequential acute wounds of human skin: An exploratory study. PLoS One 2020; 15:e0229545. [PMID: 32106276 PMCID: PMC7046225 DOI: 10.1371/journal.pone.0229545] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/08/2020] [Indexed: 01/13/2023] Open
Abstract
Profiling skin microbiome and metabolome has been utilised to gain further insight into wound healing processes. The aims of this multi-part temporal study in 11 volunteers were to analytically profile the dynamic wound tissue and headspace metabolome and sequence microbial communities in acute wound healing at days 0, 7, 14, 21 and 28, and to investigate their relationship to wound healing, using non-invasive quantitative devices. Metabolites were obtained using tissue extraction, sorbent and polydimethylsiloxane patches and analysed using GCMS. PCA of wound tissue metabolome clearly separated time points with 10 metabolites of 346 being involved in separation. Analysis of variance-simultaneous component analysis identified a statistical difference between the wound headspace metabolome, sites (P = 0.0024) and time points (P<0.0001), with 10 out of the 129 metabolites measured involved with this separation between sites and time points. A reciprocal relationship between Staphylococcus spp. and Propionibacterium spp. was observed at day 21 (P<0.05) with a statistical correlation between collagen and Propionibacterium (r = 0.417; P = 0.038) and Staphylococcus (r = -0.434; P = 0.03). Procrustes analysis showed a statistically significant similarity between wound headspace and tissue metabolome with non-invasive wound devices. This exploratory study demonstrates the temporal and dynamic nature of acute wound metabolome and microbiome presenting a novel class of biomarkers that correspond to wound healing, with further confirmatory studies now necessary.
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Affiliation(s)
- Mohammed Ashrafi
- Plastic & Reconstructive Surgery Research, Division of Musculoskeletal & Dermatological Sciences, NIHR Manchester Biomedical Research Centre (BRC), University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
- Bioengineering Group, School of Materials, University of Manchester, Manchester, United Kingdom
| | - Yun Xu
- School of Chemistry, Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
- Department of Biochemistry, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Howbeer Muhamadali
- School of Chemistry, Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
- Department of Biochemistry, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Iain White
- School of Chemistry, Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
- Laboratory for Environmental and Life Sciences, University of Nova Gorica, Nova Gorica, Slovenia
| | - Maxim Wilkinson
- School of Chemistry, Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
| | - Katherine Hollywood
- Manchester Centre for Synthetic Biology of Fine and Speciality Chemicals (SYNBIOCHEM), Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
| | - Mohamed Baguneid
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Royston Goodacre
- School of Chemistry, Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
- Department of Biochemistry, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Ardeshir Bayat
- Plastic & Reconstructive Surgery Research, Division of Musculoskeletal & Dermatological Sciences, NIHR Manchester Biomedical Research Centre (BRC), University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
- Bioengineering Group, School of Materials, University of Manchester, Manchester, United Kingdom
- * E-mail:
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Qiu L, Zhang L, Turzhitsky V, Khan U, Zakharov Y, Kantekure K, Vitkin E, Itzkan I, Pleskow DK, Sawhney M, Berzin TM, Goldsmith JD, Perelman LT. Multispectral Endoscopy with Light Gating for Early Cancer Detection. IEEE JOURNAL OF SELECTED TOPICS IN QUANTUM ELECTRONICS : A PUBLICATION OF THE IEEE LASERS AND ELECTRO-OPTICS SOCIETY 2019; 25:7201309. [PMID: 31244520 PMCID: PMC6594557 DOI: 10.1109/jstqe.2018.2854608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This paper reports the application of endoscopic light scattering spectroscopy (LSS) with light gating to detect malignancies in the biliary and pancreatic ducts, and also reviews the application of endoscopic LSS for differentiating cystic neoplasms in the pancreas and detecting invisible dysplasia in Barrett's esophagus. Information about tissue structure within the superficial epithelium where malignancy starts is present within the spectra of reflected light. Fortunately, this component of the reflected light is not yet randomized. However multiple scattering randomizes the signal from the underlying connective tissue which obscures the desired signal. In order to extract diagnostic information from the reflected signal the multiple scattering component related to connective tissue scattering and absorption must be removed. This is accomplished using described here spatial or polarization gating implemented with endoscopically compatible fiber optic probes.
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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
| | - 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
| | - 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 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
| | - Kanchan Kantekure
- Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215 USA; Department of Pathology, 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
| | - 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
| | - Douglas K. Pleskow
- Center for Advanced Endoscopy, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215 USA
| | - Mandeep Sawhney
- Center for Advanced Endoscopy, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215 USA
| | - Tyler M. Berzin
- Center for Advanced Endoscopy, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215 USA
| | - Jeffrey D. Goldsmith
- Department of Pathology, Boston Children’s Hospital, Harvard University, Boston, MA 02115 USA
| | - Lev T. Perelman
- Biological and Biomedical Sciences Program, and also with Center for Advanced Biomedical Imaging and Photonics, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02115 USA
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10
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Yemul KS, Zysk AM, Richardson AL, Tangella KV, Jacobs LK. Interpretation of Optical Coherence Tomography Images for Breast Tissue Assessment. Surg Innov 2018; 26:50-56. [PMID: 30295149 DOI: 10.1177/1553350618803245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Initial studies have shown that optical coherence tomography (OCT) is an effective margin-evaluation tool for breast-conserving surgery, but methods for the interpretation of breast OCT images have not been directly studied. In this work, breast pathologies were assessed with a handheld OCT probe. OCT images and corresponding histology were used to develop guidelines for the identification of breast tissue features in OCT images. METHODS Mastectomy and breast-conserving surgery specimens from 26 women were imaged with a handheld OCT probe. During standard pathology specimen dissection, representative 1-cm × 1-cm tissue regions were grossly identified, assessed with OCT, inked for orientation and image-matching purposes, and processed. Histology slides corresponding to the OCT image region were digitally photographed. OCT and histology images from the same region were paired by selecting the best structural matches. RESULTS In total, 2880 OCT images were acquired from 26 breast specimens (from 26 patients) and 48 matching OCT-histology image pairs were identified. These matched image pairs illustrate tissue types including adipose tissue, dense fibrosis, fibroadipose tissue, blood vessels, regular and hyperplastic ducts and lobules, cysts, cyst, fibroadenoma, invasive ductal carcinoma, invasive lobular carcinoma, ductal carcinoma in situ, calcifications, and biopsy cavities. Differentiation between pathologies was achieved by considering feature boundaries, interior appearance, posterior shadowing or enhancement, and overall morphologic patterns. CONCLUSIONS This is the first work to systematically catalog the critical features of breast OCT images. The results indicate that OCT can be used to identify and distinguish between benign and malignant features in human breast tissue.
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Affiliation(s)
| | - Adam M Zysk
- 1 Diagnostic Photonics, Inc, Chicago, IL, USA
| | - Andrea L Richardson
- 2 Sibley Memorial Hospital, Washington, DC, USA.,3 Johns Hopkins Hospital, Baltimore, MD, USA
| | - Krishnarao V Tangella
- 4 Christie Clinic, University of Illinois College of Medicine, Urbana-Champaign, IL, USA
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van Manen L, Dijkstra J, Boccara C, Benoit E, Vahrmeijer AL, Gora MJ, Mieog JSD. The clinical usefulness of optical coherence tomography during cancer interventions. J Cancer Res Clin Oncol 2018; 144:1967-1990. [PMID: 29926160 PMCID: PMC6153603 DOI: 10.1007/s00432-018-2690-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/16/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Tumor detection and visualization plays a key role in the clinical workflow of a patient with suspected cancer, both in the diagnosis and treatment. Several optical imaging techniques have been evaluated for guidance during oncological interventions. Optical coherence tomography (OCT) is a technique which has been widely evaluated during the past decades. This review aims to determine the clinical usefulness of OCT during cancer interventions focussing on qualitative features, quantitative features and the diagnostic value of OCT. METHODS A systematic literature search was performed for articles published before May 2018 using OCT in the field of surgical oncology. Based on these articles, an overview of the clinical usefulness of OCT was provided per tumor type. RESULTS A total of 785 articles were revealed by our search, of which a total of 136 original articles were available for analysis, which formed the basis of this review. OCT is currently utilised for both preoperative diagnosis and intraoperative detection of skin, oral, lung, breast, hepatobiliary, gastrointestinal, urological, and gynaecological malignancies. It showed promising results in tumor detection on a microscopic level, especially using higher resolution imaging techniques, such as high-definition OCT and full-field OCT. CONCLUSION In the near future, OCT could be used as an additional tool during bronchoscopic or endoscopic interventions and could also be implemented in margin assessment during (laparoscopic) cancer surgery if a laparoscopic or handheld OCT device will be further developed to make routine clinical use possible.
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Affiliation(s)
- Labrinus van Manen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Alexander L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Michalina J Gora
- ICube Laboratory, CNRS, Strasbourg University, Strasbourg, France
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
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12
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Takae S, Tsukada K, Maeda I, Okamoto N, Sato Y, Kondo H, Shinya K, Motani Y, Suzuki N. Preliminary human application of optical coherence tomography for quantification and localization of primordial follicles aimed at effective ovarian tissue transplantation. J Assist Reprod Genet 2018; 35:627-636. [PMID: 29607457 PMCID: PMC5949120 DOI: 10.1007/s10815-018-1166-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 03/15/2018] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the possible clinical application of optical coherence tomography for assessing ovarian reserve in individual specimens of human ovarian tissue for fertility preservation. Methods Ovarian tissue examination by optical coherence tomography was performed before ovarian tissue cryopreservation. Three of the four subjects had hematological disease or cancer, and they faced a threat to their fertility due to impending chemotherapy. One patient underwent ovarian tissue extraction for in vitro activation of dormant follicles as fertility treatment. Results The current full-field optical coherence tomography technique can detect primordial follicles in non-fixed and non-embedded human ovarian tissue. These images are well correlated with histological evaluation and the ovarian reserve test, including follicle counts. Conclusion It was demonstrated that optical coherence tomography could assess localization of primordial follicles and ovarian reserve in specimens of non-fixed human ovarian cortex, although optimization for examination of human ovarian tissue is needed for clinical application. Additionally, this technique holds the possibility of assessing the ovarian reserve of patients with unevaluable ovarian reserve. Trial registration number UMIN000023141
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Affiliation(s)
- Seido Takae
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Kosuke Tsukada
- Graduate School of Fundamental Science and Technology, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, Kanagawa, 223-8522, Japan
| | - Ichiro Maeda
- Department of Pathology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Naoki Okamoto
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Yorino Sato
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Haruhiro Kondo
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Kiemi Shinya
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan
| | - Yuki Motani
- Graduate School of Fundamental Science and Technology, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, Kanagawa, 223-8522, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8511, Japan.
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13
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Jelvehgaran P, de Bruin DM, Salguero FJ, Borst GR, Song JY, van Leeuwen TG, de Boer JF, Alderliesten T, van Herk M. Feasibility of using optical coherence tomography to detect acute radiation-induced esophageal damage in small animal models. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-12. [PMID: 29651825 DOI: 10.1117/1.jbo.23.4.046004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/26/2018] [Indexed: 05/25/2023]
Abstract
Lung cancer survival is poor, and radiation therapy patients often suffer serious treatment side effects. The esophagus is particularly sensitive leading to acute radiation-induced esophageal damage (ARIED). We investigated the feasibility of optical coherence tomography (OCT) for minimally invasive imaging of the esophagus with high resolution (10 μm) to detect ARIED in mice. Thirty mice underwent cone-beam computed tomography imaging for initial setup assessment and dose planning followed by a single-dose delivery of 4.0, 10.0, 16.0, and 20.0 Gy on 5.0-mm spots, spaced 10.0 mm apart in the esophagus. They were repeatedly imaged using OCT up to three months postirradiation. We compared OCT findings with histopathology obtained three months postirradiation qualitatively and quantitatively using the contrast-to-background-noise ratio (CNR). Histopathology mostly showed inflammatory infiltration and edema at higher doses; OCT findings were in agreement with most of the histopathological reports. We were able to identify the ARIED on OCT as a change in tissue scattering and layer thickness. Our statistical analysis showed significant difference between the CNR values of healthy tissue, edema, and inflammatory infiltration. Overall, the average CNR for inflammatory infiltration and edema damages was 1.6-fold higher and 1.6-fold lower than for the healthy esophageal wall, respectively. Our results showed the potential role of OCT to detect and monitor the ARIED in mice, which may translate to humans.
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Affiliation(s)
- Pouya Jelvehgaran
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
- Academic Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
- Institute for Laser Life and Biophotonics Amsterdam, Department of Physics and Astronomy, Amsterdam, The Netherlands
| | - Daniel Martijn de Bruin
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
- Academic Medical Center, Department of Urology, Amsterdam, The Netherlands
| | - F Javier Salguero
- The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Gerben Roelof Borst
- The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Ji-Ying Song
- The Netherlands Cancer Institute, Department of Experimental Animal Pathology, Amsterdam, The Netherlands
| | - Ton G van Leeuwen
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | - Johannes F de Boer
- Institute for Laser Life and Biophotonics Amsterdam, Department of Physics and Astronomy, Amsterdam, The Netherlands
| | - Tanja Alderliesten
- Academic Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Marcel van Herk
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
- University of Manchester, Institute of Cancer Sciences, Manchester, United Kingdom
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14
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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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15
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Swager AF, Faber DJ, de Bruin DM, Weusten BL, Meijer SL, Bergman JJ, Curvers WL, van Leeuwen TG. Quantitative attenuation analysis for identification of early Barrett's neoplasia in volumetric laser endomicroscopy. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:86001. [PMID: 28777838 DOI: 10.1117/1.jbo.22.8.086001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/17/2017] [Indexed: 06/07/2023]
Abstract
Early neoplasia in Barrett’s esophagus (BE) is difficult to detect. Volumetric laser endomicroscopy (VLE) incorporates optical coherence tomography, providing a circumferential scan of the esophageal wall layers. The attenuation coefficient (μVLE) quantifies decay of detected backscattered light versus depth, and could potentially improve BE neoplasia detection. The aim is to investigate feasibility of μVLE for identification of early BE neoplasia. In vivo and ex vivo VLE scans with histological correlation from BE patients ± neoplasia were used. Quantification by μVLE was performed manually on areas of interest (AoIs) to differentiate neoplasia from nondysplastic (ND)BE. From ex vivo VLE scans from 16 patients (13 with neoplasia), 68 AoIs were analyzed. Median μVLE values (mm−1) were 3.7 [2.1 to 4.4 interquartile range (IQR)] for NDBE and 4.0 (2.5 to 4.9 IQR) for neoplasia, not statistically different (p=0.82). Fourteen in vivo scans were used: nine from neoplastic and five from NDBE patients. Median μVLE values were 1.8 (1.5 to 2.6 IQR) for NDBE and 2.1 (1.9 to 2.6 IQR) for neoplasia, with no statistically significant difference (p=0.37). In conclusion, there was no significant difference in μVLE values in VLE scans from early neoplasia versus NDBE. Future studies with a larger sample size should explore other quantitative methods for detection of neoplasia during BE surveillance.
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Affiliation(s)
- Anne-Fre Swager
- , Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam
| | - Dirk J Faber
- , Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam
| | - Daniel M de Bruin
- , Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam
| | - Bas L Weusten
- , Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam
| | - Sybren L Meijer
- , Department of Pathology, Academic Medical Center, Amsterdam
| | - Jacques J Bergman
- , Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam
| | | | - Ton G van Leeuwen
- , Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam
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16
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Care of the Postablation Patient: Surveillance, Acid Suppression, and Treatment of Recurrence. Gastrointest Endosc Clin N Am 2017; 27:515-529. [PMID: 28577772 DOI: 10.1016/j.giec.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic eradication therapy is effective and durable for the treatment of Barrett's esophagus (BE), with low rates of recurrence of dysplasia but significant rates of recurrence of intestinal metaplasia. Identified risk factors for recurrence include age and length of BE before treatment and may also include presence of a large hiatal hernia, higher grade of dysplasia before treatment, and history of smoking. Current guidelines for surveillance following ablation are limited, with recommendations based on low-quality evidence and expert opinion. New modalities including optical coherence tomography and wide-area tissue sampling with computer-assisted analysis show promise as adjunctive surveillance modalities.
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17
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Lee HC, Ahsen OO, Liu JJ, Tsai TH, Huang Q, Mashimo H, Fujimoto JG. Assessment of the radiofrequency ablation dynamics of esophageal tissue with optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:76001. [PMID: 28687822 PMCID: PMC5499807 DOI: 10.1117/1.jbo.22.7.076001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/08/2017] [Indexed: 05/08/2023]
Abstract
Radiofrequency ablation (RFA) is widely used for the eradication of dysplasia and the treatment of early stage esophageal carcinoma in patients with Barrett’s esophagus (BE). However, there are several factors, such as variation of BE epithelium (EP) thickness among individual patients and varying RFA catheter-tissue contact, which may compromise RFA efficacy. We used a high-speed optical coherence tomography (OCT) system to identify and monitor changes in the esophageal tissue architecture from RFA. Two different OCT imaging/RFA application protocols were performed using an <italic<ex vivo</italic< swine esophagus model: (1) post-RFA volumetric OCT imaging for quantitative analysis of the coagulum formation using RFA applications with different energy settings, and (2) M-mode OCT imaging for monitoring the dynamics of tissue architectural changes in real time during RFA application. Post-RFA volumetric OCT measurements showed an increase in the coagulum thickness with respect to the increasing RFA energies. Using a subset of the specimens, OCT measurements of coagulum and coagulum + residual EP thickness were shown to agree with histology, which accounted for specimen shrinkage during histological processing. In addition, we demonstrated the feasibility of OCT for real-time visualization of the architectural changes during RFA application with different energy settings. Results suggest feasibility of using OCT for RFA treatment planning and guidance.
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Affiliation(s)
- Hsiang-Chieh Lee
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Cambridge, Massachusetts, United States
| | - Osman O. Ahsen
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Cambridge, Massachusetts, United States
| | - Jonathan J. Liu
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Cambridge, Massachusetts, United States
| | - Tsung-Han Tsai
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Cambridge, Massachusetts, United States
| | - Qin Huang
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Hiroshi Mashimo
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - James G. Fujimoto
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Cambridge, Massachusetts, United States
- Address all correspondence to: James G. Fujimoto, E-mail:
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18
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Kandel P, Wallace MB. The Role of Adjunct Imaging in Endoscopic Detection of Dysplasia in Barrett's Esophagus. Gastrointest Endosc Clin N Am 2017; 27:423-446. [PMID: 28577765 DOI: 10.1016/j.giec.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Advances in imaging technologies have demonstrated promise in early detection of dysplasia and cancer in Barrett's esophagus (BE). Optical chromoendoscopy, dye-based chromoendoscopy, and novel technologies have provided the opportunity to visualize the cellular and subcellular structures. Only narrow-band imaging and acetic acid chromoendoscopy have reached benchmarks for clinical use. Volumetric laser endomicroscopy and molecular imaging are not established for routine use. Best practice in management of BE should be focused on careful endoscopic examination, resection, or ablation of the entire abnormal lesion, as well as the use of available imaging technique that has good diagnostic accuracy.
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Affiliation(s)
- Pujan Kandel
- Department of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Michael B Wallace
- Department of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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19
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Accuracy and safety verification of ovarian reserve assessment technique for ovarian tissue transplantation using optical coherence tomography in mice ovary. Sci Rep 2017; 7:43550. [PMID: 28272468 PMCID: PMC5341097 DOI: 10.1038/srep43550] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/25/2017] [Indexed: 01/26/2023] Open
Abstract
Except for histological study, there are currently no suitable techniques available for the detection and identification of primordial follicles in ovary of primary ovarian insufficiency patients who have undetectable AMH levels. Also, the ability to locate and quantify follicles on ovarian cortex strips, without fixation, is valuable for patients who could undergo subsequent successful ovarian tissue transplantation. Although optical coherence tomography (OCT) is a well-established high resolution imaging technique without fixation commonly applied in biomedicine, few reports are available on ovarian tissue imaging. In present study, we established standard OCT follicle images at each developmental stage, including the primordial follicle, and demonstrated the efficacy of OCT to estimate IVF outcome in transplanted mice ovary like ovarian reserve tests. Unfortunately, the current commercial OCT could not be used to accurate follicle count the number of follicles for whole ovary, because the maximum depth of examination was 100 μm. And we demonstrated the safety of OCT examination, it did not affect IVF outcome and birth defect rate, and reproductive ability. Although there is room for improvement, these findings will be first step to bring OCT examination a step closer to clinical application for measuring true ovarian reserve and localizing follicles.
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20
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Komatsu Y, Landreneau R, Jobe BA. Buried Barrett Metaplasia After Endoluminal Ablation: a Ticking Time Bomb or Much Ado About Nothing? J Gastrointest Surg 2017; 21:249-250. [PMID: 27770288 DOI: 10.1007/s11605-016-3240-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/03/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Yoshihiro Komatsu
- Esophageal and Lung Institute, Allegheny Health Network, Allegheny Health Network Cancer Institute, 3rd Floor, 320 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Rodney Landreneau
- Esophageal and Lung Institute, Allegheny Health Network, Allegheny Health Network Cancer Institute, 3rd Floor, 320 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Blair A Jobe
- Esophageal and Lung Institute, Allegheny Health Network, Allegheny Health Network Cancer Institute, 3rd Floor, 320 East North Avenue, Pittsburgh, PA, 15212, USA.
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Abstract
Incidence of oesophageal adenocarcinoma has increased exponentially in the West over the past few decades. Following detection of advanced cancers, 5-year survival rates remain bleak, making identification of early neoplasia, which has a better outcome, important. Detection of subtle oesophageal lesions during endoscopy can be challenging, and advanced imaging techniques might improve their detection. High-definition endoscopy has become a standard in most endoscopy centres, and this technology probably provides better delineation of mucosal features than standard-definition endoscopy. Various image enhancement techniques are now available with the development of new electronics and software systems. Image enhancement with chromoendoscopy using dyes has been a cost-effective option for many years, yet these techniques have been replaced in some contexts by electronic chromoendoscopy, which can be used with the press of a button. However, Lugol's chromoendoscopy remains the gold standard to identify squamous dysplasia. Identification and characterization of subtle neoplastic lesions could help to target biopsies and perform endoscopic resection for better local staging and definitive therapy. In vivo histology with techniques such as confocal endomicroscopy could make endotherapy feasible within a shorter timescale than when relying on histology on tissue samples. Once early neoplasia is identified, treatments include endoscopic resection, endoscopic submucosal dissection or various ablative techniques. Endotherapy has the advantage of being a less invasive technique than oesophagectomy, and is associated with lower mortality and morbidity. Endoscopic ablation therapies have evolved over the past few years, with radiofrequency ablation showing the best results in terms of success rates and complications in Barrett dysplasia.
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22
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Swager A, Boerwinkel DF, de Bruin DM, Weusten BL, Faber DJ, Meijer SL, van Leeuwen TG, Curvers WL, Bergman JJ. Volumetric laser endomicroscopy in Barrett's esophagus: a feasibility study on histological correlation. Dis Esophagus 2016; 29:505-12. [PMID: 25951873 DOI: 10.1111/dote.12371] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Volumetric laser endomicroscopy (VLE) is a novel balloon-based optical coherence tomography (OCT) imaging technique that may improve detection of early neoplasia in Barrett's esophagus (BE). Most OCT studies lack a direct correlation between histology and OCT images. The aim is to investigate the optimal approach for achieving one-to-one correlation of ex-vivo VLE images of endoscopic resection (ER) specimens with histology. BE patients with and without early neoplasia underwent ER after delineating areas with electrocoagulation markers (ECM). After ER, specimens underwent additional ex-vivo marking with several different markers (ink, pin, Gold Probe) followed by ex-vivo VLE scanning. ER specimens were carefully sectioned into tissue blocks guided by the markers. Histology and VLE slides were considered a match if ≥ 2 markers were visible on both modalities and mucosal patterns aside from these markers matched on both histology and VLE. From 16 ER specimens 120 tissue blocks were sectioned of which 23 contained multiple markers. Fourteen histology-VLE matches were identified. ECMs and ink markers proved to be the most effective combination for matching. The last 6/16 ER specimens yielded 9/14 matches, demonstrating a learning curve due to methodological improvements in marker placement and tissue block sectioning. One-to-one correlation of VLE and histology is complex but feasible. The groundwork laid in this study will provide high-quality histology-VLE correlations that will allow further research on VLE features of early neoplasia in BE.
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Affiliation(s)
- A Swager
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - D F Boerwinkel
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - D M de Bruin
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - B L Weusten
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - D J Faber
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - S L Meijer
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - T G van Leeuwen
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - W L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - J J Bergman
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
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23
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Tang Y, Carns J, Polydorides AD, Anandasabapathy S, Richards-Kortum RR. In vivo white light and contrast-enhanced vital-dye fluorescence imaging of Barrett's-related neoplasia in a single-endoscopic insertion. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:86004. [PMID: 27533441 PMCID: PMC4979359 DOI: 10.1117/1.jbo.21.8.086004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 07/18/2016] [Indexed: 06/06/2023]
Abstract
A modular video endoscope is developed to enable both white light imaging (WLI) and vital-dye fluorescence imaging (VFI) in a single-endoscopic insertion for the early detection of cancer in Barrett’s esophagus (BE). We demonstrate that VFI can be achieved in conjunction with white light endoscopy, where appropriate white balance is used to correct for the presence of the emission filter. In VFI mode, a contrast enhancement feature is implemented in real time to further highlight glandular patterns in BE and related malignancies without introducing artifacts. In a pilot study, we demonstrate accurate correlation of images in two widefield modalities, with representative images showing the disruption and effacement of glandular architecture associated with cancer development in BE. VFI images of these alterations exhibit enhanced contrast when compared to WLI. Results suggest that the usefulness of VFI in the detection of BE-related neoplasia should be further evaluated in future in vivo studies.
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Affiliation(s)
- Yubo Tang
- Rice University, Department of Bioengineering, 6100 Main Street, MS 142, Houston, Texas 77005, United States
| | - Jennifer Carns
- Rice University, Department of Bioengineering, 6100 Main Street, MS 142, Houston, Texas 77005, United States
| | - Alexandros D. Polydorides
- Mount Sinai Medical Center, Department of Pathology, One Gustave L. Levy Place, Box 1194, New York, New York 10029-6574, United States
| | - Sharmila Anandasabapathy
- Baylor St. Luke's Medical Center, 7200 Cambridge Street, Suite 10C, Houston, Texas 77030, United States
| | - Rebecca R. Richards-Kortum
- Rice University, Department of Bioengineering, 6100 Main Street, MS 142, Houston, Texas 77005, United States
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Stier MW, Konda VJ, Hart J, Waxman I. Post-ablation surveillance in Barrett's esophagus: A review of the literature. World J Gastroenterol 2016; 22:4297-4306. [PMID: 27158198 PMCID: PMC4853687 DOI: 10.3748/wjg.v22.i17.4297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/08/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
Barrett’s esophagus (BE) is a pre-malignant condition affecting up to 15% of patients with gastroesophageal reflux disease. Neoplastic Barrett’s mucosa is defined as harboring high grade dysplasia or intra-mucosal cancer, and carries a high risk of progression to esophageal adenocarcinoma. The rising incidence of Barrett’s lesions along with the high morbidity of surgical approaches has led to the development of numerous validated endoscopic techniques capable of eradicating neoplastic mucosa in a minimally invasive manner. While there has been widespread adoption of these techniques, less is known about optimal surveillance intervals in the post-therapy period. This is due in part to limitations in current surveillance methods, questions about durability of treatment response and the risk of subendothelial progression. As we are now able to achieve organ sparing eradication of superficial neoplasia in BE, we need to also then focus our attention on how best to manage these patients after eradication is achieved. Implementing optimal surveillance practices requires additional understanding of the biology of the disease, appreciation of the limits of current tools and treatments, and exploration of the role of adjunctive technologies. The aim of this article is to provide a comprehensive review of current literature surrounding post-ablation surveillance in neoplastic BE.
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Hatta W, Uno K, Koike T, Ara N, Asano N, Iijima K, Imatani A, Fujishima F, Shimosegawa T. Feasibility of optical coherence tomography for the evaluation of Barrett's mucosa buried underneath esophageal squamous epithelium. Dig Endosc 2016; 28:427-433. [PMID: 26583560 DOI: 10.1111/den.12576] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/12/2015] [Accepted: 11/16/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The evaluation of Barrett's glands buried underneath esophageal squamous epithelium becomes increasingly important to achieve curative treatments. However, clinically available endoscopies have critical limitations in depicting the subsurface structure, resulting in non-curative treatments. Optical coherence tomography (OCT) can acquire a high-resolution cross-sectional image, equivalent to an 'optical biopsy'. We aimed to assess the feasibility of the in vivo use of probe-type OCT imaging to evaluate Barrett's mucosa buried underneath esophageal squamous epithelium METHODS: We conducted a single-center prospective study with 14 consecutive patients with Barrett's adenocarcinoma from 2008 to 2014. The enrolled patients were examined by a probe-type OCT in vivo, followed by en bloc endoscopic submucosal dissection (ESD) with electric marking. Then, the one-to-one correlations between the OCT images of the buried mucosa and their histological assessment were examined. RESULTS The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the buried mucosa in the OCT imaging were 85.7% (12/14), 77.8% (7/9), 100% (5/5), 100% (7/7) and 71.4% (5/7), respectively. However, OCT could not easily distinguish non-dysplastic glands from dysplastic glands. Additionally, the linear distance from the histological squamo-columnar junction in correct cases tended to be longer than that in incorrect cases (mm, median [range]: 2.0 [0.7-7.5] vs. 0.5 [0.5-0.5]). CONCLUSIONS We demonstrated, for the first time, that pre-operative OCT imaging might be feasible for detecting the oral side extension of buried Barrett's mucosa to remove the entire area with malignant potential by ESD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Nobuyuki Ara
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Naoki Asano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Katsunori Iijima
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Fumiyoshi Fujishima
- Department of Pathology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
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Naveed M, Dunbar KB. Endoscopic imaging of Barrett’s esophagus. World J Gastrointest Endosc 2016; 8:259-266. [PMID: 26981177 PMCID: PMC4781906 DOI: 10.4253/wjge.v8.i5.259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/14/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023] Open
Abstract
The incidence of esophageal adenocarcinoma (EAC) has dramatically increased in the United States as well as Western European countries. The majority of esophageal adenocarcinomas arise from a backdrop of Barrett’s esophagus (BE), a premalignant lesion that can lead to dysplasia and cancer. Because of the increased risk of EAC, GI society guidelines recommend endoscopic surveillance of patients with BE. The emphasis on early detection of dysplasia in BE through surveillance endoscopy has led to the development of advanced endoscopic imaging technologies. These techniques have the potential to both improve mucosal visualization and characterization and to detect small mucosal abnormalities which are difficult to identify with standard endoscopy. This review summarizes the advanced imaging technologies used in evaluation of BE.
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Chedgy FJ, Kandiah K, Thayalasekaran S, Subramaniam S, Bhandari P. Advances in the endoscopic diagnosis and treatment of Barrett's neoplasia. F1000Res 2016; 5:F1000 Faculty Rev-113. [PMID: 26918175 PMCID: PMC4755403 DOI: 10.12688/f1000research.6996.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 12/17/2022] Open
Abstract
Barrett's oesophagus is a well-recognised precursor of oesophageal adenocarcinoma. The incidence of oesophageal adenocarcinoma is continuing to rise in the Western world with dismal survival rates. In recent years, efforts have been made to diagnose Barrett's earlier and improve surveillance techniques in order to pick up cancerous changes earlier. Recent advances in endoscopic therapy for early Barrett's cancers have shifted the paradigm away from oesophagectomy and have yielded excellent results.
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Affiliation(s)
- Fergus J.Q. Chedgy
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Kesavan Kandiah
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | | | | | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
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Swager AF, Curvers WL, Bergman JJ. Diagnosis by Endoscopy and Advanced Imaging of Barrett's Neoplasia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 908:81-98. [PMID: 27573768 DOI: 10.1007/978-3-319-41388-4_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Evaluation of patients with Barrett's esophagus (BE) using dye-based chromoendoscopy, optical chromoendoscopy, autofluorescence imaging, or confocal laser endomicroscopy does not significantly increase the number of patients with a diagnosis of early neoplasia compared with high-definition white light endoscopy (HD-WLE) with random biopsy analysis. These newer imaging techniques are not more effective in standard surveillance of patients with BE because the prevalence of early neoplasia is low and HD-WLE with random biopsy analysis detects most cases of neoplasia. The evaluation and treatment of patients with BE and early stage neoplasia should be centralized in tertiary referral centers, where procedures are performed under optimal conditions, by expert endoscopists. Lesions that require resection are almost always detected by HD-WLE, although advanced imaging techniques can detect additional flat lesions. However, these are of limited clinical significance because they are effectively eradicated by ablation therapy. No endoscopic imaging technique can reliably assess submucosal or lymphangio invasion. Endoscopic resection of early stage neoplasia in patients with BE is important for staging and management. Optical chromoendoscopy can also be used to evaluate lesions before endoscopic resection and in follow-up after successful ablation therapy.
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Affiliation(s)
- Anne-Fré Swager
- Department of Gastroenterology and Hepatology, Academic Medical Center, Room B1-245, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Wouter L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands
| | - Jacques J Bergman
- Department of Gastroenterology and Hepatology, Academic Medical Center, Room B1-245, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
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29
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Swager AF, Boerwinkel DF, de Bruin DM, Faber DJ, van Leeuwen TG, Weusten BL, Meijer SL, Bergman JJ, Curvers WL. Detection of buried Barrett's glands after radiofrequency ablation with volumetric laser endomicroscopy. Gastrointest Endosc 2016; 83:80-8. [PMID: 26124075 DOI: 10.1016/j.gie.2015.05.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/20/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The prevalence and clinical relevance of buried Barrett's glands (BB) after radiofrequency ablation (RFA) in Barrett's esophagus (BE) are debated. Recent optical coherence tomography studies demonstrated a high prevalence of BBs. Direct histological correlation, however, has been lacking. Volumetric laser endomicroscopy (VLE) is a second-generation optical coherence tomography system capable of scanning a large surface of the esophageal wall layers with low-power microscopy resolution. The aim was to evaluate whether post-RFA subsquamous glandular structures (SGSs), detected with VLE, actually correspond to BBs by pursuing direct histological correlation with VLE images. METHODS In vivo VLE was performed to detect SGSs in patients with endoscopic regression of BE post-RFA. A second in vivo VLE scan was performed to confirm correct delineation of the SGSs. After endoscopic resection, the specimens were imaged ex vivo with VLE. Extensive histological sectioning of SGS areas was performed, and all histology slides were evaluated by an expert BE pathologist. RESULTS Seventeen patients underwent successful in vivo VLE (histological diagnosis before endoscopic treatment: early adenocarcinoma in 8 patients and high-grade dysplasia in 9). In 4 of 17 patients, no SGSs were identified during VLE, and a random resection was performed. In the remaining 13 patients (76%), VLE detected SGS areas, which were all confirmed on a second in vivo VLE scan and subsequently resected. Most SGSs identified by VLE corresponded to normal histological structures (eg, dilated glands and blood vessels). However, 1 area containing BBs was found on histology. No specific VLE features to distinguish between BBs and normal SGSs were identified. CONCLUSIONS VLE is able to detect subsquamous esophageal structures. One area showed BBs beneath endoscopically normal-appearing neosquamous epithelium; however, most post-RFA SGSs identified by VLE correspond to normal histological structures. ( CLINICAL TRIAL REGISTRATION NUMBER NTR4056.).
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Affiliation(s)
- Anne-Fré Swager
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - David F Boerwinkel
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Daniel M de Bruin
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | - Dirk J Faber
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | - Ton G van Leeuwen
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | - Bas L Weusten
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Sybren L Meijer
- Department of Biomedical Engineering, Academic Medical Center, Amsterdam, the Netherlands
| | - Jacques J Bergman
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Wouter L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
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Sharma P, Brill J, Canto M, DeMarco D, Fennerty B, Gupta N, Laine L, Lieberman D, Lightdale C, Montgomery E, Odze R, Tokar J, Kochman M. White Paper AGA: Advanced Imaging in Barrett's Esophagus. Clin Gastroenterol Hepatol 2015; 13:2209-18. [PMID: 26462567 DOI: 10.1016/j.cgh.2015.09.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 02/07/2023]
Abstract
Enhanced imaging technologies such as narrow band imaging, flexible spectral imaging color enhancement, i-Scan, confocal laser endomicroscopy, and optical coherence tomography are readily available for use by endoscopists in routine clinical practice. In November 2014, the American Gastroenterological Association's Center for GI Innovation and Technology conducted a 2-day workshop to discuss endoscopic image enhancement technologies, focusing on their role in 2 specific clinical conditions (colon polyps and Barrett's esophagus) and on issues relating to training and implementation of these technologies (white papers). Although the majority of the studies that use enhanced imaging technologies have been positive, these techniques ideally need to be validated in larger cohorts and in community centers. As it stands today, detailed endoscopic examination with high-definition white-light endoscopy and random 4-quadrant biopsy remains the standard of care. However, the workshop panelists agreed that in the hands of endoscopists who have met the preservation and incorporation of valuable endoscopic innovation thresholds (diagnostic accuracy) with enhanced imaging techniques (specific technologies), use of the technique in Barrett's esophagus patients is appropriate.
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Affiliation(s)
- Prateek Sharma
- University of Kansas School of Medicine, Kansas City, Missouri.
| | - Joel Brill
- Predictive Health, LLC, Paradise Valley, Arizona
| | | | | | | | - Neil Gupta
- Loyola University Health System, Chicago, Illinois
| | - Loren Laine
- Yale School of Medicine, New Haven, Connecticut
| | | | - Charles Lightdale
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | | | - Robert Odze
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey Tokar
- Temple/Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Michael Kochman
- University of Pennsylvania Health System, Philadelphia, Pennsylvania
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31
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Sturm MB, Wang TD. Emerging optical methods for surveillance of Barrett's oesophagus. Gut 2015; 64:1816-23. [PMID: 25975605 PMCID: PMC5019028 DOI: 10.1136/gutjnl-2013-306706] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 04/17/2015] [Indexed: 12/20/2022]
Abstract
The rapid rise in incidence of oesophageal adenocarcinoma has motivated the need for improved methods for surveillance of Barrett's oesophagus. Early neoplasia is flat in morphology and patchy in distribution and is difficult to detect with conventional white light endoscopy (WLE). Light offers numerous advantages for rapidly visualising the oesophagus, and advanced optical methods are being developed for wide-field and cross-sectional imaging to guide tissue biopsy and stage early neoplasia, respectively. We review key features of these promising methods and address their potential to improve detection of Barrett's neoplasia. The clinical performance of key advanced imaging technologies is reviewed, including (1) wide-field methods, such as high-definition WLE, chromoendoscopy, narrow-band imaging, autofluorescence and trimodal imaging and (2) cross-sectional techniques, such as optical coherence tomography, optical frequency domain imaging and confocal laser endomicroscopy. Some of these instruments are being adapted for molecular imaging to detect specific biological targets that are overexpressed in Barrett's neoplasia. Gene expression profiles are being used to identify early targets that appear before morphological changes can be visualised with white light. These targets are detected in vivo using exogenous probes, such as lectins, peptides, antibodies, affibodies and activatable enzymes that are labelled with fluorescence dyes to produce high contrast images. This emerging approach has potential to provide a 'red flag' to identify regions of premalignant mucosa, outline disease margins and guide therapy based on the underlying molecular mechanisms of cancer progression.
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Affiliation(s)
- Matthew B Sturm
- Division of Gastroenterology Departments of Medicine, Biomedical Engineering, Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA,Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Thomas D Wang
- Division of Gastroenterology Departments of Medicine, Biomedical Engineering, Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA,Departments of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA,Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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32
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Singh A, Chak A. Advances in the management of Barrett's esophagus and early esophageal adenocarcinoma. Gastroenterol Rep (Oxf) 2015; 3:303-15. [PMID: 26486568 PMCID: PMC4650977 DOI: 10.1093/gastro/gov048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 08/24/2015] [Indexed: 12/17/2022] Open
Abstract
The incidence of esophageal adenocarcinoma (EAC) has markedly increased in the United States over the last few decades. Barrett’s esophagus (BE) is the most significant known risk factor for this malignancy. Theoretically, screening and treating early BE should help prevent EAC but the exact incidence of BE and its progression to EAC is not entirely known and cost-effectiveness studies for Barrett’s screening are lacking. Over the last few years, there have been major advances in our understanding of the epidemiology, pathogenesis and endoscopic management of BE. These developments focus on early recognition of advanced histology and endoscopic treatment of high-grade dysplasia. Advanced resection techniques now enable us to endoscopically treat early esophageal cancer. In this review, we will discuss these recent advances in diagnosis and treatment of Barrett’s esophagus and early esophageal adenocarcinoma.
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Affiliation(s)
- Ajaypal Singh
- Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Amitabh Chak
- Division of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Cleveland, OH, USA
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33
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Uno K, Koike T, Shimosegawa T. Recent development of optical coherence tomography for preoperative diagnosis of esophageal malignancies. World J Gastrointest Endosc 2015; 7:872-80. [PMID: 26240688 PMCID: PMC4515421 DOI: 10.4253/wjge.v7.i9.872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/20/2015] [Accepted: 06/15/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic diagnosis with histological evidence is necessary to decide the best strategy for treating esophageal squamous cell carcinoma and Barrett's-associated neoplasia, and the recent development of endoscopic technologies have made possible real-time information of malignant hallmarks. We focused on the development of optical coherence tomography (OCT), the only technology that can depict real-time cross-sectional images with high resolution. With the improvements in image resolution, acquisition rate and demonstrable area of three-dimensional devices with Doppler capability, OCT imaging was shown to enable visualization of structural/functional alterations in the mucosal/submucosal tissue of the esophagus, resulting in more accurate preoperative diagnosis of such malignancies. Moreover, it approved to be useful for targeting malignant areas for biopsy and treatment as well as for predicting the treatment effects. Therefore, further development of this technology is expected to overcome the current clinical issues in management strategies of esophageal malignancies.
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Abstract
CONTEXT Inhaled nanoparticles can migrate to the brain via the olfactory bulb, as demonstrated in experiments in several animal species. This route of exposure may be the mechanism behind the correlation between air pollution and human neurodegenerative diseases, including Alzheimer's disease and Parkinson's disease. OBJECTIVES This article aims to (i) estimate the dose of inhaled nanoparticles that deposit in the human olfactory epithelium during nasal breathing at rest and (ii) compare the olfactory dose in humans with our earlier dose estimates for rats. MATERIALS AND METHODS An anatomically-accurate model of the human nasal cavity was developed based on computed tomography scans. The deposition of 1-100 nm particles in the whole nasal cavity and its olfactory region were estimated via computational fluid dynamics (CFD) simulations. Our CFD methods were validated by comparing our numerical predictions for whole-nose deposition with experimental data and previous CFD studies in the literature. RESULTS In humans, olfactory dose of inhaled nanoparticles is highest for 1-2 nm particles with ∼1% of inhaled particles depositing in the olfactory region. As particle size grows to 100 nm, olfactory deposition decreases to 0.01% of inhaled particles. DISCUSSION AND CONCLUSION Our results suggest that the percentage of inhaled particles that deposit in the olfactory region is lower in humans than in rats. However, olfactory dose per unit surface area is estimated to be higher in humans in the 1--7 nm size range due to the larger inhalation rate in humans. These dose estimates are important for risk assessment and dose-response studies investigating the neurotoxicity of inhaled nanoparticles.
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Affiliation(s)
- Guilherme J M Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin , Milwaukee, WI , USA
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35
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Abstract
Barrett's esophagus (BE) is present in up to 5.6% of the US population and is the precursor lesion for esophageal adenocarcinoma. Surveillance endoscopy is the primary management approach for BE. However, standard protocol biopsies have been associated with significant miss rates of dysplastic lesions in patients with BE. Thus, a variety of methods to optimize the imaging of BE have been developed to improve the efficiency and diagnostic yield of surveillance endoscopy in detecting early neoplasia. These techniques use changes that occur at macroscopic, microscopic, and subcellular levels in early neoplasia and are the focus of this article.
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Affiliation(s)
- V Raman Muthusamy
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 330-37, Los Angeles, CA 90095, USA.
| | - Stephen Kim
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 330-37, Los Angeles, CA 90095, USA
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo School of Medicine, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Thekkek N, Lee MH, Polydorides AD, Rosen DG, Anandasabapathy S, Richards-Kortum R. Quantitative evaluation of in vivo vital-dye fluorescence endoscopic imaging for the detection of Barrett's-associated neoplasia. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:56002. [PMID: 25950645 PMCID: PMC4423850 DOI: 10.1117/1.jbo.20.5.056002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/20/2015] [Indexed: 05/21/2023]
Abstract
Current imaging tools are associated with inconsistent sensitivity and specificity for detection of Barrett's-associated neoplasia. Optical imaging has shown promise in improving the classification of neoplasia in vivo. The goal of this pilot study was to evaluate whether in vivo vital dye fluorescence imaging (VFI) has the potential to improve the accuracy of early-detection of Barrett's-associated neoplasia. In vivo endoscopic VFI images were collected from 65 sites in 14 patients with confirmed Barrett's esophagus (BE), dysplasia, oresophageal adenocarcinoma using a modular video endoscope and a high-resolution microendoscope(HRME). Qualitative image features were compared to histology; VFI and HRME images show changes in glandular structure associated with neoplastic progression. Quantitative image features in VFI images were identified for objective image classification of metaplasia and neoplasia, and a diagnostic algorithm was developed using leave-one-out cross validation. Three image features extracted from VFI images were used to classify tissue as neoplastic or not with a sensitivity of 87.8% and a specificity of 77.6% (AUC = 0.878). A multimodal approach incorporating VFI and HRME imaging can delineate epithelial changes present in Barrett's-associated neoplasia. Quantitative analysis of VFI images may provide a means for objective interpretation of BE during surveillance.
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Affiliation(s)
- Nadhi Thekkek
- Rice University, Department of Bioengineering, MS-142, Box 1892, Houston, Texas 77251-1892, United States
- Address all correspondence to: Nadhi Thekkek, E-mail:
| | - Michelle H. Lee
- Icahn School of Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1069, New York, New York 10029-6574, United States
| | - Alexandros D. Polydorides
- Icahn School of Medicine, Mount Sinai Medical Center, Department of Pathology, One Gustave L. Levy Place, Box 1194, New York, New York 10029-6574, United States
| | - Daniel G. Rosen
- Baylor College of Medicine, Department of Pathology, One Baylor Plaza, Cullen 271A, Houston, Texas 77030, United States
| | - Sharmila Anandasabapathy
- Baylor College of Medicine, Department of Medicine, One Baylor Plaza, Cullen 271A, Houston, Texas 77030, United States
| | - Rebecca Richards-Kortum
- Rice University, Department of Bioengineering, MS-142, Box 1892, Houston, Texas 77251-1892, United States
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Yang JM, Favazza C, Yao J, Chen R, Zhou Q, Shung KK, Wang LV. Three-dimensional photoacoustic endoscopic imaging of the rabbit esophagus. PLoS One 2015; 10:e0120269. [PMID: 25874640 PMCID: PMC4398324 DOI: 10.1371/journal.pone.0120269] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 01/14/2015] [Indexed: 12/20/2022] Open
Abstract
We report photoacoustic and ultrasonic endoscopic images of two intact rabbit esophagi. To investigate the esophageal lumen structure and microvasculature, we performed in vivo and ex vivo imaging studies using a 3.8-mm diameter photoacoustic endoscope and correlated the images with histology. Several interesting anatomic structures were newly found in both the in vivo and ex vivo images, which demonstrates the potential clinical utility of this endoscopic imaging modality. In the ex vivo imaging experiment, we acquired high-resolution motion-artifact-free three-dimensional photoacoustic images of the vasculatures distributed in the walls of the esophagi and extending to the neighboring mediastinal regions. Blood vessels with apparent diameters as small as 190 μm were resolved. Moreover, by taking advantage of the dual-mode high-resolution photoacoustic and ultrasound endoscopy, we could better identify and characterize the anatomic structures of the esophageal lumen, such as the mucosal and submucosal layers in the esophageal wall, and an esophageal branch of the thoracic aorta. In this paper, we present the first photoacoustic images showing the vasculature of a vertebrate esophagus and discuss the potential clinical applications and future development of photoacoustic endoscopy.
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Affiliation(s)
- Joon Mo Yang
- Optical Imaging Laboratory, Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Christopher Favazza
- Optical Imaging Laboratory, Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Junjie Yao
- Optical Imaging Laboratory, Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Ruimin Chen
- National Institutes of Health Ultrasonic Transducer Resource Center, Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States of America
| | - Qifa Zhou
- National Institutes of Health Ultrasonic Transducer Resource Center, Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States of America
| | - K. Kirk Shung
- National Institutes of Health Ultrasonic Transducer Resource Center, Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States of America
| | - Lihong V. Wang
- Optical Imaging Laboratory, Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, Missouri, United States of America
- * E-mail:
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Abstract
Barrett's esophagus is the only known precursor that predisposes patients to the development of esophageal adenocarcinoma. The current recommended surveillance method is targeted biopsies of any abnormalities followed by random four-quadrant biopsies every 2 cm using standard white light endoscopy. Compliance with this and sampling error are two of the biggest problems. Several novel imaging technologies have been developed to aid the diagnosis of early neoplasia in Barrett's esophagus. There are emerging data that some of these new modalities can increase the yield of detecting dysplasia. This review will discuss some of the present available techniques and technologies including chromoendoscopy, narrow-band imaging, autofluorescence imaging, optical coherence tomography, confocal endomicroscopy and endocytoscopy. Based on the current evidence, these imaging modalities appear to be promising as adjunctive tools to white light endoscopy. A few of them, nevertheless, remain experimental due to expense, lack of expertise, generalizability as well as reproducibility of results.
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Affiliation(s)
- Rajvinder Singh
- University of Adelaide, Lyell McEwin Hospital, Gastroenterology and Surgery, Haydown Road, Elizabeth Vale, 5112 Australia
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39
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Robles LY, Singh S, Fisichella PM. Emerging enhanced imaging technologies of the esophagus: spectroscopy, confocal laser endomicroscopy, and optical coherence tomography. J Surg Res 2015; 195:502-14. [PMID: 25819772 DOI: 10.1016/j.jss.2015.02.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/04/2015] [Accepted: 02/18/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite advances in diagnoses and therapy, esophageal adenocarcinoma remains a highly lethal neoplasm. Hence, a great interest has been placed in detecting early lesions and in the detection of Barrett esophagus (BE). Advanced imaging technologies of the esophagus have then been developed with the aim of improving biopsy sensitivity and detection of preplastic and neoplastic cells. The purpose of this article was to review emerging imaging technologies for esophageal pathology, spectroscopy, confocal laser endomicroscopy (CLE), and optical coherence tomography (OCT). METHODS We conducted a PubMed search using the search string "esophagus or esophageal or oesophageal or oesophagus" and "Barrett or esophageal neoplasm" and "spectroscopy or optical spectroscopy" and "confocal laser endomicroscopy" and "confocal microscopy" and "optical coherence tomography." The first and senior author separately reviewed all articles. Our search identified: 19 in vivo studies with spectroscopy that accounted for 1021 patients and 4 ex vivo studies; 14 clinical CLE in vivo studies that accounted for 941 patients and 1 ex vivo study with 13 patients; and 17 clinical OCT in vivo studies that accounted for 773 patients and 2 ex vivo studies. RESULTS Human studies using spectroscopy had a very high sensitivity and specificity for the detection of BE. CLE showed a high interobserver agreement in diagnosing esophageal pathology and an accuracy of predicting neoplasia. We also found several clinical studies that reported excellent diagnostic sensitivity and specificity for the detection of BE using OCT. CONCLUSIONS Advanced imaging technology for the detection of esophageal lesions is a promising field that aims to improve the detection of early esophageal lesions. Although advancing imaging techniques improve diagnostic sensitivities and specificities, their integration into diagnostic protocols has yet to be perfected.
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Affiliation(s)
| | - Satish Singh
- Division of Gastroenterology, Boston VA Healthcare System, Boston University, Boston, Massachusetts
| | - Piero Marco Fisichella
- Department of Surgery, Boston VA Healthcare System, Harvard Medical School, Boston, Massachusetts.
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40
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Swager A, Curvers WL, Bergman JJ. Diagnosis by endoscopy and advanced imaging. Best Pract Res Clin Gastroenterol 2015; 29:97-111. [PMID: 25743459 DOI: 10.1016/j.bpg.2014.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/26/2014] [Indexed: 01/31/2023]
Abstract
Evaluation of patients with Barrett's oesophagus (BO) using dye-based chromoendoscopy, optical chromoendoscopy, autofluorescence imaging, or confocal laser endomicroscopy does not significantly increase the number of patients with a diagnosis of early neoplasia compared with high-definition white light endoscopy (HD-WLE) with random biopsy analysis. These newer imaging techniques are not more effective in standard surveillance of patients with BO because the prevalence of early neoplasia is low and HD-WLE with random biopsy analysis detects most cases of neoplasia. The evaluation and treatment of patients with BO and early-stage neoplasia should be centralized in tertiary referral centers, where procedures are performed under optimal conditions, by expert endoscopists. Lesions that require resection are almost always detected by HD-WLE, although advanced imaging techniques can detect additional flat lesions. However, these are of limited clinical significance because they are effectively eradicated by ablation therapy. No endoscopic imaging technique can reliably assess submucosal or lymphangio-invasion. Endoscopic resection of early-stage neoplasia in patients with BO is important for staging and management. Optical chromoendoscopy can also be used to evaluate lesions before endoscopic resection and in follow-up after successful ablation therapy.
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Affiliation(s)
- A Swager
- Dept. of Gastroenterology and Hepatology Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | - W L Curvers
- Dept. of Gastroenterology and Hepatology Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | - J J Bergman
- Dept. of Gastroenterology and Hepatology Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
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41
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Vogler N, Heuke S, Bocklitz TW, Schmitt M, Popp J. Multimodal Imaging Spectroscopy of Tissue. ANNUAL REVIEW OF ANALYTICAL CHEMISTRY (PALO ALTO, CALIF.) 2015; 8:359-87. [PMID: 26070717 DOI: 10.1146/annurev-anchem-071114-040352] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Advanced optical imaging technologies have experienced increased visibility in medical research, as they allow for a label-free and nondestructive investigation of tissue in either an excised state or living organisms. In addition to a multitude of ex vivo studies proving the applicability of these optical imaging approaches, a transfer of various modalities toward in vivo diagnosis is currently in progress as well. Furthermore, combining optical imaging techniques, referred to as multimodal imaging, allows for an improved diagnostic reliability due to the complementary nature of retrieved information. In this review, we provide a summary of ongoing multifold efforts in multimodal tissue imaging and focus in particular on in vivo applications for medical diagnosis. We also discuss the advantages and potential limitations of the imaging methods and outline opportunities for future developments.
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Affiliation(s)
- Nadine Vogler
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich-Schiller University Jena, 07743 Jena, Germany;
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42
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Wang T, Brewer M, Zhu Q. An overview of optical coherence tomography for ovarian tissue imaging and characterization. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2015; 7:1-16. [PMID: 25329515 PMCID: PMC4268384 DOI: 10.1002/wnan.1306] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/18/2014] [Accepted: 09/02/2014] [Indexed: 12/12/2022]
Abstract
Ovarian cancer has the lowest survival rate among all the gynecologic cancers because it is predominantly diagnosed at late stages due to the lack of reliable symptoms and efficacious screening techniques. Optical coherence tomography (OCT) is an emerging technique that provides high-resolution images of biological tissue in real time, and demonstrates great potential for imaging of ovarian tissue. In this article, we review OCT studies for visualization and diagnosis of human ovaries as well as quantitative extraction of ovarian tissue optical properties for classifying normal and malignant ovaries. OCT combined with other imaging modalities to further improve ovarian tissue diagnosis is also reviewed.
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Affiliation(s)
- Tianheng Wang
- Department of Electrical and Computer Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Molly Brewer
- Division of Gynecologic Oncology, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Quing Zhu
- Department of Electrical and Computer Engineering & Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
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43
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Yang JM, Favazza C, Yao J, Chen R, Zhou Q, Shung KK, Wang LV. Three-dimensional photoacoustic endoscopic imaging of the rabbit esophagus. PLoS One 2015. [PMID: 25874640 DOI: 10.1371/journal.pone.012026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
We report photoacoustic and ultrasonic endoscopic images of two intact rabbit esophagi. To investigate the esophageal lumen structure and microvasculature, we performed in vivo and ex vivo imaging studies using a 3.8-mm diameter photoacoustic endoscope and correlated the images with histology. Several interesting anatomic structures were newly found in both the in vivo and ex vivo images, which demonstrates the potential clinical utility of this endoscopic imaging modality. In the ex vivo imaging experiment, we acquired high-resolution motion-artifact-free three-dimensional photoacoustic images of the vasculatures distributed in the walls of the esophagi and extending to the neighboring mediastinal regions. Blood vessels with apparent diameters as small as 190 μm were resolved. Moreover, by taking advantage of the dual-mode high-resolution photoacoustic and ultrasound endoscopy, we could better identify and characterize the anatomic structures of the esophageal lumen, such as the mucosal and submucosal layers in the esophageal wall, and an esophageal branch of the thoracic aorta. In this paper, we present the first photoacoustic images showing the vasculature of a vertebrate esophagus and discuss the potential clinical applications and future development of photoacoustic endoscopy.
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Affiliation(s)
- Joon Mo Yang
- Optical Imaging Laboratory, Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Christopher Favazza
- Optical Imaging Laboratory, Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Junjie Yao
- Optical Imaging Laboratory, Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Ruimin Chen
- National Institutes of Health Ultrasonic Transducer Resource Center, Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States of America
| | - Qifa Zhou
- National Institutes of Health Ultrasonic Transducer Resource Center, Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States of America
| | - K Kirk Shung
- National Institutes of Health Ultrasonic Transducer Resource Center, Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States of America
| | - Lihong V Wang
- Optical Imaging Laboratory, Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, Missouri, United States of America
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44
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Hammad H, Kaltenbach T, Soetikno R. Endoscopic submucosal dissection for malignant esophageal lesions. Curr Gastroenterol Rep 2014; 16:386. [PMID: 24659252 DOI: 10.1007/s11894-014-0386-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The incidence of esophageal cancer has been increasing while the prognosis remains very poor. Endoscopic submucosal dissection (ESD) was developed in Japan for en bloc resection of early gastric cancer with excellent results. The use of ESD in early squamous cell cancer (SCC) of the esophagus in Japan has been increasing with long-term results comparable to those in early gastric cancer. The use of ESD in Barrett's neoplasia in western countries has been challenged by the low complete resection rates and the risk of metachronous lesions from surrounding non-dysplastic Barrett's epithelium. Efforts to combine ESD with other treatment modalities such as radiofrequency ablation in Barrett's neoplasia and chemoradiation in SCC appear to be promising. The use of steroid therapy (local or systemic) has been demonstrated to prevent post-ESD stenosis, which is the most common complication after esophageal ESD.
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Affiliation(s)
- Hazem Hammad
- Harry S. Truman Memorial Veterans Hospital, University of Missouri Hospital and Clinics, Columbia, MO, USA,
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45
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Tsai TH, Fujimoto JG, Mashimo H. Endoscopic Optical Coherence Tomography for Clinical Gastroenterology. Diagnostics (Basel) 2014; 4:57-93. [PMID: 26852678 PMCID: PMC4665545 DOI: 10.3390/diagnostics4020057] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/18/2014] [Accepted: 04/22/2014] [Indexed: 12/12/2022] Open
Abstract
Optical coherence tomography (OCT) is a real-time optical imaging technique that is similar in principle to ultrasonography, but employs light instead of sound waves and allows depth-resolved images with near-microscopic resolution. Endoscopic OCT allows the evaluation of broad-field and subsurface areas and can be used ancillary to standard endoscopy, narrow band imaging, chromoendoscopy, magnification endoscopy, and confocal endomicroscopy. This review article will provide an overview of the clinical utility of endoscopic OCT in the gastrointestinal tract and of recent achievements using state-of-the-art endoscopic 3D-OCT imaging systems.
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Affiliation(s)
- Tsung-Han Tsai
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Hiroshi Mashimo
- Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA 02115, USA.
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46
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Affiliation(s)
- Werner Dolak
- Medical University of Vienna, Internal Medicine III., Division of Gastroenterology and Hepatology,Corresponding author Werner Dolak Medical University of ViennaInternal Medicine III., Division of Gastroenterology and HepatologyWaehringer Guertel 18-201090 ViennaAustria0043-1-40400-4735
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47
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Ianiro G, Gasbarrini A, Cammarota G. Endoscopic tools for the diagnosis and evaluation of celiac disease. World J Gastroenterol 2013; 19:8562-8570. [PMID: 24379573 PMCID: PMC3870501 DOI: 10.3748/wjg.v19.i46.8562] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/28/2013] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is an autoimmune disease of the small bowel induced by ingestion of wheat, rye and barley. Current guidelines indicate histological analysis on at least four duodenal biopsies as the only way to diagnose CD. These indications are based on the conception of the inability of standard endoscopy to make diagnosis of CD and/or to drive biopsy sampling. Over the last years, technology development of endoscopic devices has greatly ameliorated the accuracy of macroscopic evaluation of duodenal villous pattern, increasing the diagnostic power of endoscopy of CD. The aim of this paper is to review the new endoscopic tools and procedures proved to be useful in the diagnosis of CD, such as chromoendoscopy, Fujinon Intelligent Chromo Endoscopy, Narrow Band Imaging, Optical Coherence Tomography, Water-Immersion Technique, confocal laser endomicroscopy, high-resolution magnification endoscopy, capsule endoscopy and I-Scan technology.
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48
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Enhanced imaging in the GI tract: spectroscopy and optical coherence tomography. Gastrointest Endosc 2013; 78:568-73. [PMID: 24054739 DOI: 10.1016/j.gie.2013.07.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/11/2013] [Indexed: 02/07/2023]
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49
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Assayag O, Antoine M, Sigal-Zafrani B, Riben M, Harms F, Burcheri A, Grieve K, Dalimier E, Le Conte de Poly B, Boccara C. Large field, high resolution full-field optical coherence tomography: a pre-clinical study of human breast tissue and cancer assessment. Technol Cancer Res Treat 2013; 13:455-68. [PMID: 24000981 PMCID: PMC4527436 DOI: 10.7785/tcrtexpress.2013.600254] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We present a benchmark pilot study in which high-resolution Full-Field Optical Coherence Tomography (FF-OCT) was used to image human breast tissue and is evaluated to assess its ability to aid the pathologist’s management of intra-operative diagnoses. FF-OCT imaging safety was investigated and agreement between FF-OCT and routinely prepared histopathological images was evaluated. The compact setup used for this study provides 1 µm3 resolution and 200 µm imaging depth, and a 2.25 cm2 specimen is scanned in about 7 minutes. 75 breast specimens were imaged from 22 patients (21 women, 1 man) with a mean age of 58 (range: 25-83). Pathologists blind diagnosed normal/benign or malignant tissue based on FF-OCT images alone, diagnosis from histopathology followed for comparison. The contrast in the FF-OCT images is generated by intrinsic tissue scattering properties, meaning that no tissue staining or preparation is required. Major architectural features and tissue structures of benign breast tissue, including adipocytes, fibrous stroma, lobules and ducts were characterized. Subsequently, features resulting from pathological modification were characterized and a diagnosis decision tree was developed. Using FF-OCT images, two breast pathologists were able to distinguish normal/benign tissue from lesional with a sensitivity of 94% and 90%, and specificity of 75% and 79% respectively.
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50
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Subsquamous intestinal metaplasia after ablation of Barrett's esophagus: frequency and importance. Curr Opin Gastroenterol 2013; 29:454-9. [PMID: 23674187 DOI: 10.1097/mog.0b013e3283622796] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This article reviews reports on the prevalence of subsquamous intestinal metaplasia (SSIM) in patients with Barrett's esophagus, and the implications of SSIM in the neoplastic progression of Barrett's esophagus to esophageal adenocarcinoma. RECENT FINDINGS Endoscopic eradication therapy for dysplastic Barrett's esophagus has become an encouraging alternative to esophagectomy or continued endoscopic surveillance. However, the presence of SSIM before and after ablation is concerning because this tissue may have potential for malignant progression, is not visible by conventional endoscopy, and may evade detection by random esophageal biopsy sampling methods. Advances in endoscopic high-resolution three-dimensional optical coherence tomography recently have revealed SSIM in a majority of patients both before and after complete eradication of Barrett's esophagus by radiofrequency ablation. Studies suggest that although cells of Barrett's glands are highly proliferative, the cells of these buried glands are more dormant. Nevertheless, the malignant potential of SSIM cells remains undetermined. SUMMARY Novel endoscopic imaging demonstrates that SSIM is present in the majority of patients with Barrett's esophagus, both before and after ablative therapy. Although these subsquamous cells exhibit less proliferative activity than those of typical surface Barrett's glands, the malignant potential of the buried glands, especially when challenged by injurious factors, remains largely unknown. Future methods to detect subsurface dysplasia will be needed.
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