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Hoffman A, Manner H, Rey JW, Kiesslich R. A guide to multimodal endoscopy imaging for gastrointestinal malignancy - an early indicator. Nat Rev Gastroenterol Hepatol 2017; 14:421-434. [PMID: 28611477 DOI: 10.1038/nrgastro.2017.46] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Multimodality imaging is an essential aspect of endoscopic surveillance for the detection of neoplastic lesions, such as dysplasia or intramucosal cancer, because it improves the efficacy of endoscopic surveillance and therapeutic procedures in the gastrointestinal tract. This approach reveals mucosal abnormalities that cannot be detected by standard endoscopy. Currently, these imaging techniques are divided into those for primary detection and those for targeted imaging and characterization, the latter being used to visualize areas of interest in detail and permit histological evaluation. This Review outlines the use of virtual chromoendoscopy, narrow-band imaging, autofluorescence imaging, optical coherence tomography, confocal endomicroscopy and volumetric laser endomicroscopy as new imaging techniques for diagnostic investigation of the gastrointestinal tract. Insights into use of multimodal endoscopic imaging for early disease detection, in particular for pre-malignant lesions, in the oesophagus, stomach and colon are described.
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Affiliation(s)
- Arthur Hoffman
- Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Germany
| | - Henrik Manner
- Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Germany
| | - Johannes W Rey
- Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Germany
| | - Ralf Kiesslich
- Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Germany
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Abstract
BACKGROUND Patients with ulcerative colitis are at increased risk for colorectal cancer and endoscopic surveillance is mandatory. Matrix metalloproteinases (MMPs)-2 and -9 activities are increased in malignant colonic mucosa. The aim of the study was to evaluate molecular imaging of MMP-2/-9 by fluorescence endoscopy (FE) for early tumor detection. METHODS Colorectal cancer in mice (n = 28) was induced by azoxymethane and dextran sodium sulfate. Twenty-four hours after intravenous injection of a nonpeptidic, Cy5.5-labeled MMP-selective tracer, tumor development was assessed in vivo by white light endoscopy and FE. Topical administration of the tracer was also investigated (after 5 minutes and 24 hours). Colonic tumors were evaluated ex vivo by fluorescence reflectance imaging, immunohistochemistry, Western blot analysis, and zymography. RESULTS Imaging of MMP-2/-9 expression by FE achieved a significantly higher contrast of the fluorescence signal in colonic adenomas compared with the adjacent nonmalignant mucosa (P < 0.001). Fluorescence reflectance imaging detected a significantly higher tracer uptake in adenoma compared with healthy mucosa (P < 0.001) and revealed a tumor size-dependent increase of tracer uptake (P < 0.01). Topical tracer administration did not facilitate tumor detection. Immunohistochemistry, Western blot analysis, and zymography indicated higher levels of MMP-2 and -9 in high-grade dysplasia and pT1 tumors ex vivo. CONCLUSIONS MMP-2/-9 expression was significantly increased in colorectal neoplasia. FE allows direct visualization of a prognostic parameter (here MMP-2/-9) on a molecular level and may improve the characterization of colorectal lesions and the adenoma detection rate in the future.
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Buchner AM, Wallace MB. In-vivo microscopy in the diagnosis of intestinal neoplasia and inflammatory conditions. Histopathology 2015; 66:137-46. [PMID: 25639481 DOI: 10.1111/his.12597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Confocal laser endomicroscopy (CLE) is a rapidly emerging tool in endoscopic imaging allowing in-vivo microscopy of examined gastrointestinal mucosa. This review will discuss the most recent advances of confocal laser endomicroscopy in the diagnosis of intestinal neoplasia and inflammatory conditions.
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Affiliation(s)
- Anna M Buchner
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
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Serrano M, Kikuste I, Dinis-Ribeiro M. Advanced endoscopic imaging for gastric cancer assessment: new insights with new optics? Best Pract Res Clin Gastroenterol 2014; 28:1079-91. [PMID: 25439073 DOI: 10.1016/j.bpg.2014.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 09/22/2014] [Accepted: 10/01/2014] [Indexed: 01/31/2023]
Abstract
The most immediate strategy for improving survival of gastric cancer patients is secondary prevention through diagnosis of early gastric cancer either through screening or follow-up of individuals at high risk. Endoscopy examination is therefore of paramount importance and two general steps are to be known in assessing gastric mucosa - detection and characterization. Over the past decade, the advent of advanced endoscopic imaging technology led to diverse descriptions of these modalities reporting them to be useful in this setting. In this review, we aim at summarizing the current evidence on the use of advance imaging in individuals at high-risk (i.e., advance stages of gastric atrophy/intestinal metaplasia) and in those harbouring neoplastic lesions, and address its potential usefulness providing the readers a framework to use in daily practice. Further research is also suggested.
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Affiliation(s)
- M Serrano
- Gastroenterology Department, Portuguese Oncology Institute, Rua Professor Lima Basto, 1099-023 Lisbon, Portugal.
| | - I Kikuste
- Faculty of Medicine, University of Latvia, Riga, Latvia; Digestive Diseases Centre GASTRO, 6 Linezera Street, LV1006 Riga, Latvia.
| | - M Dinis-Ribeiro
- Center for Health Technology and Services Research (CINTESIS), Porto Faculty of Medicine, Porto, Portugal; Gastroenterology Department, Portuguese Oncology Institute, Rua Dr. Bernardino de Almeida, 4200-072 Porto, Portugal.
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Oh G, Yoo SW, Jung Y, Ryu YM, Park Y, Kim SY, Kim KH, Kim S, Myung SJ, Chung E. Intravital imaging of mouse colonic adenoma using MMP-based molecular probes with multi-channel fluorescence endoscopy. BIOMEDICAL OPTICS EXPRESS 2014; 5:1677-89. [PMID: 24877024 PMCID: PMC4026906 DOI: 10.1364/boe.5.001677] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/19/2014] [Accepted: 04/21/2014] [Indexed: 05/18/2023]
Abstract
Intravital imaging has provided molecular, cellular and anatomical insight into the study of tumor. Early detection and treatment of gastrointestinal (GI) diseases can be enhanced with specific molecular markers and endoscopic imaging modalities. We present a wide-field multi-channel fluorescence endoscope to screen GI tract for colon cancer using multiple molecular probes targeting matrix metalloproteinases (MMP) conjugated with quantum dots (QD) in AOM/DSS mouse model. MMP9 and MMP14 antibody (Ab)-QD conjugates demonstrate specific binding to colonic adenoma. The average target-to-background (T/B) ratios are 2.10 ± 0.28 and 1.78 ± 0.18 for MMP14 Ab-QD and MMP9 Ab-QD, respectively. The overlap between the two molecular probes is 67.7 ± 8.4%. The presence of false negative indicates that even more number of targeting could increase the sensitivity of overall detection given heterogeneous molecular expression in tumors. Our approach indicates potential for the screening of small or flat lesions that are precancerous.
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Affiliation(s)
- Gyungseok Oh
- School of Mechatronics, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Su Woong Yoo
- Department of Medical System Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Yebin Jung
- Department of Chemistry, Pohang University of Science and Technology, Pohang, South Korea
| | - Yeon-Mi Ryu
- Asan Institute for Life sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Youngrong Park
- Department of Chemistry, Pohang University of Science and Technology, Pohang, South Korea
| | - Sang-Yeob Kim
- Asan Institute for Life sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Deparment of Medicine, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ki Hean Kim
- Division of Integrative Biosciences and Biotechnology and Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, South Korea
| | - Sungjee Kim
- Department of Chemistry, Pohang University of Science and Technology, Pohang, South Korea
| | - Seung-Jae Myung
- Asan Institute for Life sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Gastroenterology, Asan Medical Center,University of Ulsan College of Medicine, Seoul, South Korea
| | - Euiheon Chung
- School of Mechatronics, Gwangju Institute of Science and Technology, Gwangju, South Korea
- Department of Medical System Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
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Choi KS, Jung HY. Confocal laser endomicroscopy and molecular imaging in barrett esophagus and stomach. Clin Endosc 2014; 47:23-30. [PMID: 24570880 PMCID: PMC3928487 DOI: 10.5946/ce.2014.47.1.23] [Citation(s) in RCA: 6] [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: 12/04/2013] [Accepted: 12/10/2013] [Indexed: 12/20/2022] Open
Abstract
Detection of premalignant lesions in the upper gastrointestinal tract may facilitate endoscopic treatment and improve survival. Despite technological advances in white light endoscopy, its ability to detect premalignant lesions remains limited. Early detection could be improved by using advanced endoscopic imaging techniques, such as magnification endoscopy, narrow band imaging, i-scanning, flexible spectral imaging color enhancement, autofluorescence imaging, and confocal laser endomicroscopy (CLE), as these techniques may increase the rate of detection of mucosal abnormalities and allow optical diagnosis. The present review focuses on advanced endoscopic imaging techniques based on the use of CLE for diagnosing premalignant lesions in Barrett esophagus and stomach.
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Affiliation(s)
- Kwi-Sook Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
Performing real-time microscopy has been a vision of endoscopists since the very early phases of gastrointestinal endoscopy. Confocal endomicroscopy, an adaption of confocal laser scanning microscopy, and endocytoscopy, an adaption of white-light microscopy, have been introduced into the endoscopic armamentarium in the past decade. Both techniques yield on-site histological information. Multiple trials have demonstrated the ability of gastroenterologists to obtain and interpret microscopic images from the upper and lower gastrointestinal tract, and also the hepatobiliary-pancreatic system, during endoscopy. Such microscopic information has been successfully used in expert hands to minimize sampling error by 'smart', microscopically targeted biopsies and to guide endoscopic interventions. However, endomicroscopy is also unique in its ability to dynamically visualize cellular processes in their native environment free of artefacts. This ability enables fundamental insights into mechanisms of human diseases in clinical and translational science.
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Abstract
Confocal laser endomicroscopy (CLE) allows microscopic imaging of the gastric mucosa in real time during endoscopy. Gastroenterologists are able to evaluate gastric pathologies in real time, which is used to target fewer biopsies to regions of interest by providing multiple "optical" biopsies, and guide endoscopic interventions. CLE provides a powerful tool for translational studies to unravel the pathophysiology of diseases in vivo virtually free of artifacts. Molecular imaging may help to detect suspicious lesions and to predict response to targeted therapy. This review provides an overview of current applications of endomicroscopy of the stomach in clinical and translational science.
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Affiliation(s)
- Martin Goetz
- Deptartment of Medicine I, University of Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany.
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Thekkek N, Pierce MC, Lee MH, Polydorides AD, Flores RM, Anandasabapathy S, Richards-Kortum RR. Modular video endoscopy for in vivo cross-polarized and vital-dye fluorescence imaging of Barrett's-associated neoplasia. JOURNAL OF BIOMEDICAL OPTICS 2013; 18:26007. [PMID: 23370452 PMCID: PMC3561596 DOI: 10.1117/1.jbo.18.2.026007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A modular video endoscope is developed and tested to allow imaging in different modalities. This system incorporates white light imaging (WLI), cross-polarized imaging (CPI), and vital-dye fluorescence imaging (VFI), using interchangeable filter modules. CPI and VFI are novel endoscopic modalities that probe mucosal features associated with Barrett's neoplasia. CPI enhances vasculature, while VFI enhances glandular architecture. In this pilot study, we demonstrate the integration of these modalities by imaging areas of Barrett's metaplasia and neoplasia in an esophagectomy specimen. We verify that those key image features are also observed during an in vivo surveillance procedure. CPI images demonstrate improved visualization of branching blood vessels associated with neoplasia. VFI images show glandular architecture with increased glandular effacement associated with neoplasia. Results suggests that important pathologic features seen in CPI and VFI are not visible during standard endoscopic white light imaging, and thus the modalities may be useful in future in vivo studies for discriminating neoplasia from Barrett's metaplasia. We further demonstrate that the integrated WLI/CPI/VFI endoscope is compatible with complementary high-resolution endomicroscopy techniques such as the high-resolution microendoscope, potentially enabling two-step ("red-flag" widefield plus confirmatory high-resolution imaging) protocols to be enhanced.
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Affiliation(s)
- Nadhi Thekkek
- Rice University, Department of Bioengineering, 6100 Main Street, MS 142, Houston, TX 77005, USA.
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