1
|
Buas MF, Gu H, Djukovic D, Zhu J, Onstad L, Reid BJ, Raftery D, Vaughan TL. Candidate serum metabolite biomarkers for differentiating gastroesophageal reflux disease, Barrett's esophagus, and high-grade dysplasia/esophageal adenocarcinoma. Metabolomics 2017; 13:23. [PMID: 28190989 PMCID: PMC5295138 DOI: 10.1007/s11306-016-1154-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION/OBJECTIVES Incidence of esophageal adenocarcinoma (EA), an often fatal cancer, has increased sharply over recent decades. Several important risk factors (reflux, obesity, smoking) have been identified for EA and its precursor, Barrett's esophagus (BE), but a key challenge remains identifying individuals at highest risk, since most with reflux do not develop BE, and most with BE do not progress to cancer. Metabolomics represents an emerging approach for identifying novel biomarkers associated with cancer development. METHODS We used targeted liquid chromatography-mass spectrometry (LC-MS) to profile 57 metabolites in 322 serum specimens derived from individuals with gastroesophageal reflux disease (GERD), BE, high-grade dysplasia (HGD), or EA, drawn from two well-annotated epidemiologic parent studies. RESULTS Multiple metabolites differed significantly (P<0.05) between BE versus GERD (n=9), and between HGD/EA versus BE (n=4). Several top candidates (FDR q≤0.15), including urate, homocysteine, and 3-nitrotyrosine, are linked to inflammatory processes, which may contribute to BE/EA pathogenesis. Multivariate modeling achieved moderate discrimination between HGD/EA and BE (AUC=0.75), with less pronounced separation for BE versus GERD (AUC=0.64). CONCLUSION Serum metabolite differences can be detected between individuals with GERD versus BE, and between those with BE versus HGD/EA, and may help differentiate patients at different stages of progression to EA.
Collapse
Affiliation(s)
- Matthew F. Buas
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109 USA
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, 14263 USA
| | - Haiwei Gu
- Northwest Metabolomics Research Center, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98109 USA
| | - Danijel Djukovic
- Northwest Metabolomics Research Center, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98109 USA
| | - Jiangjiang Zhu
- Northwest Metabolomics Research Center, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98109 USA
| | - Lynn Onstad
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109 USA
| | - Brian J. Reid
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109 USA
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109 USA
| | - Daniel Raftery
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109 USA
- Northwest Metabolomics Research Center, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98109 USA
- Correspondence: T.L.V. (, Phone: 206-667-5134, Fax: 206-667-4787; D.R. (, Phone: 206-685-4753, Fax: 206-616-4819)
| | - Thomas L. Vaughan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109 USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, 98109 USA
- Correspondence: T.L.V. (, Phone: 206-667-5134, Fax: 206-667-4787; D.R. (, Phone: 206-685-4753, Fax: 206-616-4819)
| |
Collapse
|
2
|
Reed MAC, Singhal R, Ludwig C, Carrigan JB, Ward DG, Taniere P, Alderson D, Günther UL. Metabolomic Evidence for a Field Effect in Histologically Normal and Metaplastic Tissues in Patients with Esophageal Adenocarcinoma. Neoplasia 2017; 19:165-174. [PMID: 28152423 PMCID: PMC5288314 DOI: 10.1016/j.neo.2016.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 01/26/2023] Open
Abstract
Patients with Barrett's esophagus (BO) are at increased risk of developing esophageal adenocarcinoma (EAC). Most Barrett's patients, however, do not develop EAC, and there is a need for markers that can identify those most at risk. This study aimed to see if a metabolic signature associated with the development of EAC existed. For this, tissue extracts from patients with EAC, BO, and normal esophagus were analyzed using 1H nuclear magnetic resonance. Where possible, adjacent histologically normal tissues were sampled in those with EAC and BO. The study included 46 patients with EAC, 7 patients with BO, and 68 controls who underwent endoscopy for dyspeptic symptoms with normal appearances. Within the cancer cohort, 9 patients had nonneoplastic Barrett's adjacent to the cancer suitable for biopsy. It was possible to distinguish between histologically normal, BO, and EAC tissue in EAC patients [area under the receiver operator curve (AUROC) 1.00, 0.86, and 0.91] and between histologically benign BO in the presence and absence of EAC (AUROC 0.79). In both these cases, sample numbers limited the power of the models. Comparison of histologically normal tissue proximal to EAC versus that from controls (AUROC 1.00) suggests a strong field effect which may develop prior to overt EAC and hence be useful for identifying patients at high risk of developing EAC. Excellent sensitivity and specificity were found for this model to distinguish histologically normal squamous esophageal mucosa in EAC patients and healthy controls, with 8 metabolites being very significantly altered. This may have potential diagnostic value if a molecular signature can detect tissue from which neoplasms subsequently arise.
Collapse
Affiliation(s)
- Michelle A C Reed
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Rishi Singhal
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Christian Ludwig
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - John B Carrigan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Douglas G Ward
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | | | - Derek Alderson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Ulrich L Günther
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| |
Collapse
|
3
|
Yang Y, Wang L, Wang S, Liang S, Chen A, Tang H, Chen L, Deng F. Study of metabonomic profiles of human esophageal carcinoma by use of high-resolution magic-angle spinning 1H NMR spectroscopy and multivariate data analysis. Anal Bioanal Chem 2013; 405:3381-9. [PMID: 23455688 DOI: 10.1007/s00216-013-6774-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/20/2012] [Accepted: 01/22/2013] [Indexed: 11/30/2022]
Abstract
Esophageal carcinoma (EC) is one of the most common malignant tumors. EC survival has remained disappointingly low because of the high malignancy of esophageal cancer and the lack of obvious clinical symptoms at an early stage. Early diagnosis is often difficult because the small tumor nodules are frequently missed. Metabonomics based on high-resolution magic-angle spinning (HRMAS) NMR has been popular for tumor detection because it is highly sensitive, provides rich biochemical information and requires no sample pretreatment. (1)H HRMAS spectra of non-involved adjacent esophageal tissues and of well differentiated and moderately differentiated esophageal carcinoma tumors were recorded and analyzed by use of multivariate and statistical analysis techniques. Moderately differentiated EC tumors were found to have increased total choline, alanine, and glutamate and reduced creatine, myo-inositol, and taurine compared with non-involved adjacent tissues. Moreover, clear differences between the metabonomic profiles of EC tissues enabled tumor differentiation. Furthermore, the integral Gly/MI ratio for samples of different tissue types were statistically significantly different; this was sufficient both for distinguishing non-involved tissues from esophageal carcinoma and for classification of well differentiated and moderately differentiated EC tumors.
Collapse
Affiliation(s)
- Yongxia Yang
- Vascular Biology Research Institute, Guangdong Pharmaceutical University, Guangzhou, China.
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Diagnostic value of 8.5 T magnetic resonance spectroscopy of benign and malignant skin lesion biopsies. Melanoma Res 2010; 20:311-7. [PMID: 20626102 DOI: 10.1097/cmr.0b013e32833bd0ec] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Proton magnetic resonance spectroscopy at 8.5 T ex vivo was used to investigate skin lesions for metabolic signatures to predict malignancy or indicate malignant potential. Magnetic resonance spectroscopy was performed on biopsy tissue obtained from 63 skin lesions and five melanoma metastases from 55 patients. Samples were grouped and compared according to five clinically significant distinctions: melanoma (n=38) or nonmelanoma (n=30), primary melanoma (n=33) or secondary melanoma (involved nodes and distant metastases, n=5), primary melanoma (n=33) or nevi (n=8), malignant (n=46) or nonmalignant (n=22), and melanocytic (n=46) or nonmelanocytic (n=22). In all comparisons, the average magnetic resonance spectrum of each class lay within 1 standard deviation of the average spectrum of the other class. There was a higher average choline metabolite signal intensity in melanoma-containing biopsies compared with nonmelanoma biopsies. Discriminant analysis based on the intensity of the choline resonance alone achieved 69% accuracy in separation of melanoma and nonmelanoma tissue. Inclusion of other metabolite resonances in the analysis did not increase discrimination accuracy. Tissue heterogeneity in conventionally collected full thickness skin biopsies and possible biochemical variance within individual tissue types limit classification accuracy using the methods and magnetic field strength that were earlier reported to provide accurate discrimination in other cancer types.
Collapse
|
5
|
Bezabeh T, Somorjai R, Dolenko B, Bryskina N, Levin B, Bernstein CN, Jeyarajah E, Steinhart AH, Rubin DT, Smith ICP. Detecting colorectal cancer by 1H magnetic resonance spectroscopy of fecal extracts. NMR IN BIOMEDICINE 2009; 22:593-600. [PMID: 19259992 DOI: 10.1002/nbm.1372] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Colorectal cancer is one of the most common cancers in the western world. Its early detection has been found to improve the prognosis of the patient, providing a wide window of opportunity for successful therapeutic interventions. However, current diagnostic techniques all have some limitations; there is a need to develop a better technique for routine screening purposes. We present a new methodology based on magnetic resonance spectroscopy of fecal extracts for the non-invasive detection of colorectal cancer. Five hundred twenty-three human subjects (412 with no colonic neoplasia and 111 with colorectal cancer, who were scheduled for colonoscopy or surgery) were recruited to donate a single sample of stool. One-dimensional (1)H magnetic resonance spectroscopy (MRS) experiments were performed on the supernatant of aqueous dispersions of the stool samples. Using a statistical classification strategy, several multivariate classifiers were developed. Applying the preprocessing, feature selection and classifier development stages of the Statistical Classification Strategy led to approximately 87% average balanced sensitivity and specificity for both training and monitoring sets, improving to approximately 92% when only crisp results, i.e. class assignment probabilities > or =75%, are considered. These results indicate that (1)H magnetic resonance spectroscopy of human fecal extracts, combined with appropriate data analysis methodology, has the potential to detect colorectal neoplasia accurately and reliably, and could be a useful addition to the current screening tools.
Collapse
Affiliation(s)
- T Bezabeh
- Institute for Biodiagnostics, National Research Council, 435 Ellice Ave., Winnipeg, Manitoba, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Ng WH, Lim T. Targeting regions with highest lipid content on MR spectroscopy may improve diagnostic yield in stereotactic biopsy. J Clin Neurosci 2008; 15:502-6. [PMID: 18334298 DOI: 10.1016/j.jocn.2007.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Revised: 03/28/2007] [Accepted: 04/03/2007] [Indexed: 11/16/2022]
Abstract
Gliomas are heterogeneous brain tumors and prognosis and treatment are dependent on the highest histological grade present. Stereotactic biopsy is associated with an inherent risk of sampling error. Magnetic resonance spectroscopy (MRS) uses clinical MR scanners to provide chemical in addition to conventional information. MRS studies in brain tumors have found increased levels of choline-containing compounds (Cho) and decreased levels of N-acetylaspartate (NAA), creatine (Cr) and phosphocreatine (PCr) which are all associated with increased grade of glioma. We propose the use of MRS-guided stereotactic biopsy of astrocytomas to increase diagnostic yield and reduce the sampling error rate. MRS was performed on two patients undergoing stereotactic biopsy for suspected astrocytoma. Spectral peak heights of the metabolites Cho at 3.2 parts per million (ppm) chemical shift, NAA at 2.0 ppm and lipid (Lip) at 1.2 ppm, were measured. Biopsy targets were selected from the voxels with the highest Cho/NAA and normalised against Cho levels in the contralateral normal tissue, as well as those with highest lipid content. The biopsies were taken and tissue diagnosis was obtained via standard histological techniques. Histological grade was found to be different in one case: the region with a high Lip/Cr and Cho/NAA ratios showed glioblastoma, whereas the region with high Cho/NAA but low Lip/Cr ratios showed anaplastic astrocytoma. The second patient had high Cho/NAA ratio but low Lip/Cr ratio in both targets and the histology revealed anaplastic astrocytoma in both samples. MRS is a useful biomedical imaging tool for diagnosing and grading astrocytomas. Targeting regions with highest lipid content can potentially improve the diagnostic yield and minimize sampling error in stereotactic biopsy.
Collapse
Affiliation(s)
- Wai Hoe Ng
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
| | | |
Collapse
|
7
|
Goyal L, Hingmire S, Parikh PM. Newer Diagnostic Methods in Oncology. Med J Armed Forces India 2006; 62:162-8. [PMID: 27407884 PMCID: PMC4921993 DOI: 10.1016/s0377-1237(06)80062-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 03/25/2006] [Indexed: 12/25/2022] Open
Affiliation(s)
- L Goyal
- Senior Registrar, Tata Memorial Hospital, Parel, Mumbai
| | - S Hingmire
- Senior Registrar, Tata Memorial Hospital, Parel, Mumbai
| | - Purvish M Parikh
- Professor and Chief of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai
| |
Collapse
|
8
|
Mountford C, Lean C, Malycha P, Russell P. Proton spectroscopy provides accurate pathology on biopsy and in vivo. J Magn Reson Imaging 2006; 24:459-77. [PMID: 16897689 DOI: 10.1002/jmri.20668] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the last 25 years, MR spectroscopy (MRS) has moved from being a basic research tool into routine clinical use. The spectroscopy method reports on those chemicals that are mobile on the MR time scale. Many of these chemicals reflect specific pathological processes but are complicated by the fact that many chemicals change at one time. There are currently two clinical applications for spectroscopy. The first is in the pathology laboratory, where it can be an adjunct to, and in some cases replacement, for difficult pathologies like Barrett's esophagus and follicular adenoma of the thyroid. The spectroscopy method on a breast biopsy can also report on prognostic indicators, including the potential for spread, from information present in the primary tumor alone. The second application for spectroscopy is in vivo to provide a preoperative diagnosis and this is now achievable for several organs including the prostate. The development of spectroscopy for clinical purposes has relied heavily on the serially-sectioned histopathology to confirm the high accuracy of the method. The combination of in vivo MRI, in vivo MRS, and ex vivo MRS on biopsy samples offers a modality of very high accuracy for preoperative diagnosis and provision of prognostic information for human cancers.
Collapse
Affiliation(s)
- Carolyn Mountford
- Institute for Magnetic Resonance Research, University of Sydney, Sydney, New South Wales, Australia.
| | | | | | | |
Collapse
|
9
|
Abstract
Ex vivo and in vivo applications of magnetic resonance spectroscopy have been developed which aid in distinguishing malignant from normal tissues. Studies of breast, colon, cervix, oesophageal and prostate cancer reveal both the successes and failings of present technology. Verification that these non-invasive tests might supplant conventional histology in obtaining spatial diagnostic and chemical prognostic information remains for the time being illusive.
Collapse
Affiliation(s)
- Laurence Gluch
- Department of Breast and Endocrine Surgery, Concord Hospital, Sydney, New South Wales, Australia.
| |
Collapse
|
10
|
Stretch JR, Somorjai R, Bourne R, Hsiao E, Scolyer RA, Dolenko B, Thompson JF, Mountford CE, Lean CL. Melanoma Metastases in Regional Lymph Nodes Are Accurately Detected by Proton Magnetic Resonance Spectroscopy of Fine-Needle Aspirate Biopsy Samples. Ann Surg Oncol 2005; 12:943-9. [PMID: 16177860 DOI: 10.1245/aso.2005.03.073] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 06/29/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nonsurgical assessment of sentinel nodes (SNs) would offer advantages over surgical SN excision by reducing morbidity and costs. Proton magnetic resonance spectroscopy (MRS) of fine-needle aspirate biopsy (FNAB) specimens identifies melanoma lymph node metastases. This study was undertaken to determine the accuracy of the MRS method and thereby establish a basis for the future development of a nonsurgical technique for assessing SNs. METHODS FNAB samples were obtained from 118 biopsy specimens from 77 patients during SN biopsy and regional lymphadenectomy. The specimens were histologically evaluated and correlated with MRS data. Histopathologic analysis established that 56 specimens contained metastatic melanoma and that 62 specimens were benign. A linear discriminant analysis-based classifier was developed for benign tissues and metastases. RESULTS The presence of metastatic melanoma in lymph nodes was predicted with a sensitivity of 92.9%, a specificity of 90.3%, and an accuracy of 91.5% in a primary data set. In a second data set that used FNAB samples separate from the original tissue samples, melanoma metastases were predicted with a sensitivity of 87.5%, a specificity of 90.3%, and an accuracy of 89.1%, thus supporting the reproducibility of the method. CONCLUSIONS Proton MRS of FNAB samples may provide a robust and accurate diagnosis of metastatic disease in the regional lymph nodes of melanoma patients. These data indicate the potential for SN staging of melanoma without surgical biopsy and histopathological evaluation.
Collapse
Affiliation(s)
- Jonathan R Stretch
- Sydney Melanoma Unit and Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Dave U, Taylor-Robinson SD, Walker MM, Mahon M, Puri BK, Thursz MR, DeSouza NM, Cox IJ. In vitro 1H-magnetic resonance spectroscopy of Barrett's esophageal mucosa using magic angle spinning techniques. Eur J Gastroenterol Hepatol 2004; 16:1199-205. [PMID: 15489582 DOI: 10.1097/00042737-200411000-00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES In vitro proton magnetic resonance spectroscopy (MRS) allows changes in cell membrane lipid structure associated with dysplasia and malignant transformation to be investigated. Magic angle spinning (MAS) MRS allows small esophageal tissue specimens to be studied directly without the need to extract the tissue, but it is not known how intact the tissue architecture remains after MAS. We report the first prospective MAS MRS study of Barrett's esophagus using endoscopic biopsies with direct histological correlation. METHODS Biopsies were obtained during surveillance esophagoscopy from Barrett's epithelium and adjacent normal squamous epithelium in 16 patients (34 samples). High-resolution MAS MRS was performed at 500 MHz. Following MRS, the histology was evaluated. A further, separate group of 14 biopsies were examined histologically to assess architectural damage caused by tissue preservation alone. RESULTS For squamous and Barrett's epithelium, respectively, metabolite ratios of choline-containing compounds to creatine plus phosphocreatine (Cho/Cr) were 1.99 and 5.65 (P < 10) and methyl lipid to creatine plus phosphocreatine ratios (lipid-CH3/Cr) were 4.07 and 7.4 (P < 10). There was no significant difference in histological preservation between the squamous and Barrett's mucosa without MRS (z = 0.67, P = 0.61), but significant differences were found post-MAS MRS (z = 4.06, P < 0.0001). CONCLUSIONS Squamous and Barrett's epithelium can be distinguished metabolically, based on Cho/Cr and lipid-CH3/Cr ratios. Although MAS does affect the histological architecture in Barrett's epithelium, compared with squamous epithelium, direct histological assessment was possible in the majority of samples.
Collapse
Affiliation(s)
- Umakant Dave
- Division of Medicine A, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Mountford CE, Doran S, Lean CL, Russell P. Proton MRS Can Determine the Pathology of Human Cancers with a High Level of Accuracy. Chem Rev 2004; 104:3677-704. [PMID: 15303833 DOI: 10.1021/cr030410g] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Carolyn E Mountford
- Institute for Magnetic Resonance Research, P.O. Box 148, St. Leonards, 1590 NSW, Australia.
| | | | | | | |
Collapse
|
13
|
Song LMWK, Wang KK. Optical detection and eradication of dysplastic Barrett's esophagus. Technol Cancer Res Treat 2003; 2:289-302. [PMID: 12892511 DOI: 10.1177/153303460300200403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dysplastic Barrett's esophagus is a condition that offers multiple diagnostic and therapeutic challenges. The diagnosis of dysplasia within Barrett's esophagus currently relies on periodic endoscopic surveillance with multiple biopsies, a methodology limited by random sampling error, inconsistent histopathologic interpretation and delay in diagnosis. Optical spectroscopic and imaging techniques have the potential to identify dysplastic or early neoplastic lesions in real-time. These diagnostic modalities are needed to enhance the endoscopic surveillance of Barrett's esophagus in the future as well as help to define lesions for endoscopic therapy. Esophagectomy has been the standard of care for Barrett's esophagus with high-grade dysplasia although it is a procedure associated with significant morbidity and mortality. Minimally invasive endoscopic ablative therapies are attractive and less morbid alternatives to esophagectomy, with promising results obtained from the use of light-activated drugs (i.e., photodynamic therapy). The combination of novel optical diagnostic techniques and therapies will provide the endoscopist with much needed tools that can considerably enhance the management of patients with Barrett's esophagus. This article reviews the current status and future prospects of optical-based modalities for diagnosis and therapy of dysplastic Barrett's esophagus.
Collapse
|
14
|
Swindle P, McCredie S, Russell P, Himmelreich U, Khadra M, Lean C, Mountford C. Pathologic characterization of human prostate tissue with proton MR spectroscopy. Radiology 2003; 228:144-51. [PMID: 12832578 DOI: 10.1148/radiol.2281011808] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the accuracy of magnetic resonance (MR) spectroscopy in documenting the chemical features of human prostate tissue and to ascertain if there are chemical criteria of diagnostic importance. MATERIALS AND METHODS Seventy-seven prostate tissue specimens (peripheral zone, n = 61; transitional zone, n = 16) from 43 patients were analyzed with MR spectroscopy. Histologic features were compared with MR spectroscopic data. Statistical analysis was undertaken with analysis of variance and computer software. RESULTS Histologically identified carcinomas were determined by using MR spectroscopy with a sensitivity of 100% and a specificity of 94%. Histologically benign tissue from patients without carcinoma of the prostate was distinguished from malignant tissue with a sensitivity of 100% and a specificity of 94%. When benign specimens from patients with cancer elsewhere in the prostate were included in the database, MR spectroscopy helped distinguish benign prostatic hyperplasia from adenocarcinoma with a sensitivity of 97% and specificity of 88%. Depleted citrate and elevated choline levels alone were not accurate markers of malignancy, since citrate levels remain high when a small amount of malignant disease is present. Carcinomas missed at routine histologic examination were identified with MR spectroscopy and confirmed with specialized, nonstandard histologic examination. CONCLUSION By comparing the intensity of resonances assigned to choline, creatine, lipid, and lysine, MR spectroscopy can depict prostate carcinoma with a high degree of sensitivity and specificity. Citrate and choline resonances alone are not sufficiently accurate markers for distinguishing between various patterns of prostatic disease.
Collapse
Affiliation(s)
- Peter Swindle
- Institute for Magnetic Resonance Research and Department of Magnetic Resonance in Medicine, University of Sydney, Block 3 Level 3, Royal North Shore Hospital, St Leonard's, New South Wales, 2065, Australia
| | | | | | | | | | | | | |
Collapse
|
15
|
Neural networks and genetic algorithms applications in nuclear magnetic resonance spectroscopy. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s0922-3487(03)23010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|