Virtual biopsies in Barrett's esophagus using an impedance probe

Computational Modelling for Electrical Impedance Spectroscopy-Based Diagnosis of Oral Potential Malignant Disorders (OPMD)

A multiscale modelling approach has been applied to the simulation of the electrical properties of oral tissue, for the purpose of informing an electrical impedance-based method of oral potential malignant disorder (OPMD) diagnosis. Finite element models of individual cell types, with geometry informed by histological analysis of human oral tissue (normal, hyperplastic and dysplastic), were generated and simulated to obtain electrical parameters. These were then used in a histology-informed tissue scale model, including the electrode geometry of the ZedScan tetrapolar impedance-measurement device. The simulations offer insight into the feasibility of distinguishing moderate dysplasia from severe dysplasia or healthy tissue. For some oral sites, simulated spectra agreed with real measurements previously collected using ZedScan. However, similarities between simulated spectra for dysplastic, keratinised and non-dysplastic but hyperkeratinised tissue suggest that significant keratinisation could cause some OPMD tissues to exhibit larger than expected impedance values. This could lead to misidentification of OPMD spectra as healthy. Sources of uncertainty within the models were identified and potential remedies proposed.

Preliminary study on parameterization of raw electrical bioimpedance data with 3 frequencies

This study tests the geometrical parameterization method for Electrical Bio-Impedance Spectroscopy (EBIS) readings previously proposed by one of the authors. This method uses the data of just three frequencies (therefore called 3P method). The test was carried out by the analysis of parameterization from 26 spectra (selected from 13 data sets) by the non-linear square (NLS) method, the 3P method and a combination of the two (3P-NLS). Additionally, the behaviour of the 3P method for 4 levels of noise and 3 different ways of segmenting the spectra were also explored with a MATLAB simulation of 400 spectra. Finally, a system for the classification of EBIS readings is presented, based on deviations of the raw data from the semi-circle obtained by the parameterization methods. Overall, the results suggest a very good performance of the 3P method when compared with the other two. The 3P method performs very well with levels of noise of 1 and 2%, but performs poorly with levels of noise of 5% and 10%. The results support the idea that the 3P method could be used with confidence for the parameterization of EBIS spectra, after the selection of three adequate frequencies according to specific applications.

Bioimpedance analysis as a tool for hemodynamic monitoring: overview, methods and challenges

Recent advances in hemodynamic monitoring have seen the advent of non-invasive methods which offer ease of application and improve patient comfort. Bioimpedance Analysis or BIA is one of the currently employed non-invasive techniques for hemodynamic monitoring. Impedance Cardiography (ICG), one of the implementations of BIA, is widely used as a non-invasive procedure for estimating hemodynamic parameters such as stroke volume (SV) and cardiac output (CO). Even though BIA is not a new diagnostic technique, it has failed to gain consensus as a reliable measure of hemodynamic parameters. Several devices have emerged for estimating CO using ICG which are based on evolving methodologies and techniques to calculate SV. However, the calculations are generally dependent on the electrode configurations (whole body, segmental or localised) as well as the accuracy of different techniques in tracking blood flow changes. Blood volume changes, concentration of red blood cells, pulsatile velocity profile and ambient temperature contribute to the overall conductivity of blood and hence its impedance response during flow. There is a growing interest in investigating limbs for localised BIA to estimate hemodynamic parameters such as pulse wave velocity. As such, this paper summarises the current state of hemodynamic monitoring through BIA in terms of different configurations and devices in the market. The conductivity of blood flow has been emphasized with contributions from both volume and velocity changes during flow. Recommendations for using BIA in hemodynamic monitoring have been mentioned highlighting the suitable range of frequencies (1 kHz-1 MHz) as well as safety considerations for a BIA setup. Finally, current challenges in using BIA such as geometry assumption and inaccuracies have been discussed while mentioning potential advantages of a multi-frequency analysis to cover all the major contributors to blood's impedance response during flow.

Distal Esophageal Impedance Measured by High-resolution Esophageal Manometry With Impedance Suggests the Presence of Barrett's Esophagus

Background/Aims

Barrett's esophagus (BE) is characterized by intestinal metaplasia in the distal esophagus. The aims of this study are to: (1) Compare baseline distal esophageal impedance (DEI) using high-resolution esophageal manometry with impedance (HREMI) in patients with BE, esophagitis, and healthy volunteers and (2) Correlate length of low impedance on HREMI in patients with BE to the length of endoscopic BE.

Methods

Patients with BE or esophagitis who underwent HREMI were included. Ten volunteers had HREMI. Baseline DEI was calculated from HREMI using the landmark segment. In patients with BE, the impedance was plotted to measure the extent of plotted low impedance (PLI) and visual low impedance (VLI). Lengths of VLI and PLI were correlated to endoscopic length of BE by Prague score.

Results

Forty-five patients were included (16 BE; 19 esophagitis; 10 volunteers). BE patients had lower baseline DEI at the first, second, and third sensors above the lower esophageal sphincter (mean ± SEM: 1.37 ± 0.45, 0.97 ± 0.27, and 0.81 ± 0.20) compared to volunteers (8.73 ± 0.60, 8.20 ± 0.73, and 6.94 ± 0.99; P < 0.001). Baseline DEI was lower in BE than esophagitis patients (2.98 ± 0.65, 2.49 ± 0.56, and 2.01 ± 0.51) at the first, second, and third sensors (P < 0.052 for second and third sensors); ie, BE < esophagitis < controls. PLI and VLI had a stronger correlation to circumferential score (r² = 0.84 and 0.83) than maximal score (r² = 0.76 and 0.68).

Conclusions

Baseline DEI is lower in BE compared with esophagitis and healthy volunteers. The length of low impedance correlates to the endoscopic extent of BE. Thus, impedance values during HREMI may help suggest the presence and extent of BE or esophagitis.

Design, Construction and Validation of an Electrical Impedance Probe with Contact Force and Temperature Sensors Suitable for in-vivo Measurements

Bioimpedance spectroscopy measurements can be used for tissue characterization. These measurements can be performed in soft tissues by direct contact of a non-invasive probe consisting of two or four electrodes. The amount of force applied by users can be quite different, and the measurements can vary as a result. To compensate for this, we have built an electrical impedance probe (diameter 3.2 mm) with fibre optic contact-force and temperature sensors built in it. The different sensors of the probe were tested individually. The errors in magnitude and phase angle of the probe are <0.9% and <4°, respectively, for a 0.9% NaCl solution. The linear dynamic range of the force sensor was from 0 to 100 grams. An ex-vivo experiment on a section of proximal colon from a guinea-pig was performed. Twenty bioimpedance measurements were taken in a frequency range of 5 kHz to 1 MHz, while simultaneously recording the force applied. For an increase in contact pressure applied to tissue from 0 to 15.4 kPa, the maximum change in resistivity was 33% at 5 kHz and the minimum was 6.6% at 142 kHz. The probe is small enough to be introduced via the instrument port of an endoscope.

Use of a Conical Conducting Layer with an Electrical Impedance Probe to Enhance Sensitivity in Epithelial Tissues

Tetra-polar electrical impedance measurement (TPIM) with a square geometry of electrodes is useful in the characterization of epithelial tissues, especially in the detection of cervical cancer at precancerous stages. However, in TPIM, the peak planar sensitivity just below the electrode surface is almost zero and increases to a peak value at a depth of about one third to one half of the electrode separation. To get high sensitivity for the epithelial layer, having thicknesses of 200 μm to 300 μm, the electrode separation needed is less than 1 mm, which is difficult to achieve in practical probes. This work proposes a conical conducting layer in front of a pencil like probe with a square geometry of TPIM electrodes to create virtual electrodes with much smaller separation at the body surface, thus increasing the sensitivity of the epithelial tissues. To understand the improvements, if any, 3D sensitivity distribution and transfer impedance were simulated using COMSOL Multiphysics software for a simplified body tissue model containing a 300 μm epithelial layer. It has been shown that fractional contribution of an epithelial layer can be increased several times placing a cylindrical conducting layer in between the tissue surface and the electrodes, which can further be enhanced using a conical conducting layer. The results presented in this paper can be used to choose an appropriate electrode separation, conducting layer height and cone parameters for enhanced sensitivity in the epithelial layer.

Cell Electrical Impedance as a Novel Approach for Studies on Senescence Not Based on Biomarkers

Senescence of cardiac myocytes is frequently associated with heart diseases. To analyze senescence in cardiac myocytes, a number of biomarkers have been isolated. However, due to the complex nature of senescence, multiple markers are required for a single assay to accurately depict complex physiological changes associated with senescence. In single cells, changes in both cytoplasm and cell membrane during senescence can affect the changes in electrical impedance. Based on this phenomenon, we developed MEDoS, a novel microelectrochemical impedance spectroscopy for diagnosis of senescence, which allows us to precisely measure quantitative changes in electrical properties of aging cells. Using cardiac myocytes isolated from 3-, 6-, and 18-month-old isogenic zebrafish, we examined the efficacy of MEDoS and showed that MEDoS can identify discernible changes in electrical impedance. Taken together, our data demonstrated that electrical impedance in cells at different ages is distinct with quantitative values; these results were comparable with previously reported ones. Therefore, we propose that MEDoS be used as a new biomarker-independent methodology to obtain quantitative data on the biological senescence status of individual cells.

Measurement and modelling the sensitivity of tetrapolar transfer impedance measurements

Finite element method (FEM) modelling of a small disk in a homogeneous saline medium showed that the sensitivity distribution for tetrapolar transfer impedance measurements was dependant on the ratio, σdisk/σsaline, and not absolute conductivity values. In addition, the amplitude of the negative sensitivity regions between the drive and receive electrodes decreased non-linearly with σdisk/σsaline for σdisk/σsaline < 1, eventually becoming zero. This non-linear behaviour determined the limit of the assumption of a small change in conductivity in Geselowitz's lead theorem with 0.5 <σdisk/σsaline <1.5 for the measurements reported. The modelling supported the design of a sensitivity measurement system using an insulating support and a metal disk in a saline filled tank. Measurements were shown to give good agreement with sensitivity predictions from Geselowitz's lead theorem. Replacing the homogeneous medium in the FEM model with layers of different conductivity parallel to the plane of the electrodes changed the sensitivity distribution when the thickness of the layers adjacent to the electrodes were less than ½ the electrode spacing. A layer of greater conductivity over a layer of lesser conductivity next to the electrodes gave a peak in the sensitivity distribution and extended regions of negative sensitivity further into the tissue.

Diagnosing early Barrett's neoplasia and oesophageal squamous cell neoplasia by bioimpedance spectroscopy in human tissue

BACKGROUND

Detection of early oesophageal cancer in surrounding normal tissue can be challenging, but detection is essential to determine the subsequent treatment. Dysplastic tissue can be detected by using electrical impedance spectroscopy (EIS).

OBJECTIVE

The aim of the present study was to evaluate the feasibility and value of EIS in the diagnosis of oesophageal neoplasia.

METHODS

This prospective ex-vivo study included 23 patients with early oesophageal cancer (17 with Barrett's cancer and six with early squamous cell cancer). Immediately after endoscopic resection, the electrical properties of the resected specimens were investigated using a pencil probe (5 mm in diameter, frequency range from 100 Hz to 1 MHz). Punch biopsies were taken from the measured site in order to compare the results of EIS with histology.

RESULTS

EIS was able to detect dysplastic oesophageal mucosa with a high rate of accuracy (82% in Barrett's oesophagus and 100% in squamous oesophagus) A total of 54 different sites in 26 tumours were evaluated.

CONCLUSIONS

EIS was able to differentiate reliably between non-neoplastic and neoplastic oesophageal mucosa. Using EIS, it might be possible to use it for targeted biopsies and to avoid unnecessary biopsies during cancer surveillance in future.

The possible use of combined electrical impedance and ultrasound velocity measurements for the non-invasive measurement of temperature during mild hyperthermia

This paper explores the possibility of using combined measurements of electrical impedance and changes in ultrasound time of flight for determining deep body temperature during mild hyperthermia. Simultaneous electrical impedance spectra (1 kHz-1024 kHz) and ultrasound time-of-flight measurements were made on layered sheep liver and fat tissue samples as the temperature was increased from 30-50 °C. The change in propagation velocity for 100% fat and 100% liver samples was found to vary linearly with temperature and the temperature coefficient of the time-of-flight was shown to vary linearly with the % fat in the sample (0.009% °C-1%-1). Tetrapolar impedance measurements normalized to 8 kHz were shown to have a small sensitivity to temperature for both liver (0.001% °C-1 ≤ 45 °C) and fat (0.002% °C-1 ≤ 512 kHz) and the best linear correlation between the normalized impedance and the % fat in the sample was found at 256 kHz (gradient 0.026%-1, r2 = 0.65). A bootstrap analysis on 15 layered tissue samples evaluated using the normalized impedance at 256 kHz to determine the % fat in the sample and the temperature coefficient of the time of flight to determine the temperature. The results showed differences (including some large differences) between the predicted and measured temperatures and an error evaluation identified the possible origins of these.

Electrical tissue impedance spectroscopy: a novel device to measure esophageal mucosal integrity changes during endoscopy

BACKGROUND

Patients with gastroesophageal reflux disease (GERD) have impaired esophageal mucosal integrity. Measurement of the mucosal integrity is complex and time-consuming. Electrical tissue impedance spectroscopy (ETIS) is a device that measures impedance of tissue in vivo during endoscopy. In this study, we aimed to validate ETIS as a measure of esophageal mucosal integrity.

METHODS

Electrical tissue impedance spectroscopy measurements were performed during upper endoscopy in 12 GERD patients and 11 healthy controls after cessation of proton pump inhibition. During endoscopy biopsies of the distal esophagus were obtained for transmission electron microscopy to determine dilation of intercellular spaces (DIS) and for Ussing chamber experiments to determine transepithelial permeability and transepithelial electrical resistance.

KEY RESULTS

Extracellular impedance measured in vivo by ETIS was significantly lower in GERD patients compared to controls [mean (SD) 5621 (3299) Ω.m and 8834 (2542) Ω.m, respectively, P < 0.05]. We found a strong inverse relation between extracellular impedance determined by ETIS and DIS (r = -0.76, P < 0.05), and between extracellular resistance in vivo and transepithelial permeability of esophageal biopsies (r = -0.65, P < 0.01).

CONCLUSIONS & INFERENCES

Electrical tissue impedance spectroscopy is a new tool that can be used to evaluate esophageal mucosal integrity changes during endoscopy.

Bladder cancer detection using electrical impedance technique (tabriz mark 1)

Bladder cancer is the fourth most common malignant neoplasm in men and the eighth in women. Bladder pathology is usually investigated visually by cystoscopy. In this technique, biopsies are obtained from the suspected area and then, after needed procedure, the diagnostic information can be taken. This is a relatively difficult procedure and is associated with discomfort for the patient and morbidity. Therefore, the electrical impedance spectroscopy (EIS), a minimally invasive screening technique, can be used to separate malignant areas from nonmalignant areas in the urinary bladder. The feasibility of adapting this technique to screen for bladder cancer and abnormalities during cystoscopy has been explored and compared with histopathological evaluation of urinary bladder lesions. Ex vivo studies were carried out in this study by using a total of 30 measured points from malignant and 100 measured points from non-malignant areas of patients bladders in terms of their biopsy reports matching to the electrical impedance measurements. In all measurements, the impedivity of malignant area of bladder tissue was significantly higher than the impedivity of non-malignant area this tissue (P < 0.005).

Bioimpedance spectroscopy: a new tool to assess early esophageal changes linked to gastroesophageal reflux disease?

Bioimpedance spectroscopy can identify pathological changes related to precancerous lesions of the cervix uteri and esophagus. It therefore has the potential to detect early reflux-related changes in the esophageal mucosa, such as dilated intercellular spaces. The reliable detection of dilated intercellular spaces at the time of endoscopy would yield a significant diagnostic advantage for separating patients with functional heartburn from the large proportion of patients with gastroesophageal reflux symptoms but no macroscopic esophagitis or pathological acid exposure. The bioimpedance of the esophageal mucosa, measured with a small caliber probe, was evaluated in a series of preclinical experiments. First, sections of rabbit esophageal epithelium were mounted in Ussing chambers and exposed to solutions at pH 7.4 or pH 1.5 for 45 minutes. Impedance measurements were taken at varying probe pressures. Second, rabbit esophageal epithelia were perfused for 45 minutes in situ with pH 1.1 or control solutions and impedance measurements taken. Samples from both in vitro and in situ experiments were taken for morphological examination by light microscopy. Finally, esophageal bioimpedance was measured in awake dogs with permanent esophagocutaneous stoma. The in situ experiments demonstrated that morphological changes in the esophageal mucosa could be discerned by the use of bioimpedance spectroscopy. The variability in resistivity was species-independent but was affected by the pressure applied to the probe. The results suggest that evaluation of bioimpedance spectroscopy for use in a clinical setting is warranted. Small morphological differences in the esophageal mucosa may be detected by the use of bioimpedance spectroscopy.

Some early results related to electrical impedance of normal and abnormal gastric tissue

Gastric cancer is the fourth most common cancer and most patients with gastric cancer are being diagnosed in advanced stages of the disease so they do not gain any survival chance from conventional surgical, chemotherapeutic or radiotherapeutic methods. These are relatively high cost procedures in terms of both time and money. This study considers the introduction of a novel minimally invasive diagnostic technique which shows the relationship between histopathology and the electrical impedance spectrum in the human stomach. In this study, 4 electrode technique was used to differentiate tissues from each other using Tabriz Mark 1 electrical impedance system (30 different frequencies in the range of 2 kHz to 1 MHz). A total of 97 points from 45 patients were studied in terms of their biopsy reports matching to the electrical impedance measurements (in vivo). After impedance measurements and applying calibration factors, a non-parametric statistical technique, the Kruskal-Wallis test was used to evaluate the difference among the groups. According to the calculation of respective data using this spectroscopy system, the resistivity of the normal group was higher than that of the benign group, and the resistivity of these groups were higher than that of the malignant group at frequencies between 470 kHz and 1 MHz (P < 0.05). In these frequencies, the impedivity of the dysplastic tissue was significantly lower than that of the other groups (P < 0.05). Also, Cole equation fitting procedure was used to generate a scatter plot of the malignant and benign points: it shows in general, benign points had higher values of R than the malignant points. Therefore, electrical impedance spectroscopy can be a useful technique to characterize the stomach tissue.

The sensitivity of focused electrical impedance measurements

One of the problems with tetrapolar impedance measurements is the lack of spatial sensitivity within the measured volume. In this paper we compare the sensitivity of tetrapolar measurements and the focused impedance measurements (FIM) proposed by Rabbani et al (1999 Ann. New York Acad. Sci. 873 408-20), which give an improved sensitivity profile. Using a previously validated model of sensitivity based on Geselowitz's lead theory, the sensitivity of FIM using eight, six and four electrodes was investigated. All electrode configurations showed a maximum in the average sensitivity of a plane at a depth of one-third of the drive-receive electrode spacing. No difference was found in the sensitivity value of this maximum between electrode configurations having the same drive-receive electrode spacing. The six- and eight-electrode configurations showed negative sensitivity regions down to half of the drive-receive electrode spacing, whilst the four-electrode measurement showed negative sensitivity regions down to one-third of the drive-receive electrode spacing. The single peak in sensitivity beneath the centre of the electrode configuration became dominant at 0.56, 1.4 and 0.14 of the receive electrode spacing for the eight-, six- and four-electrode configurations respectively. Thus, the four-electrode FIM configuration gives a single peak closest to the surface.

Surface fluids effects on the bladder tissue characterisation using electrical impedance spectroscopy

The electrical impedance of the human urinary bladder in both benign and malignant areas can be measured using an electrical impedance spectroscopy system (EIS). Glycine is usually used in the bladder surgery in the theatre to make an insulation medium for electro-surgery and the extension of the mucosa. In addition, a saline solution is usually used to wash the inside of the bladder after bladder surgery and it is used to extend the bladder tissue mucosa. Therefore, the effect of glycine and the saline solution that fills the bladder is important, because it was expected that the application of common surface fluids (air, saline solution and glycine solution) in the bladder epithelium would affect the measured electrical impedance of the urothelium, to differentiate the malignant area from the normal bladder tissue. In this study, bladders were removed from the patients' bodies and then were moved from theatre to the histopathology department immediately after excision. These bladder samples were then opened and pinned to a corkboard to take the impedance readings, using the impedance spectroscopy system. Following this, the bladder and corkboard were completely submerged in a saline solution and readings were taken at about 1cm from the sutures. Subsequently, this procedure was repeated with the bladder submerged in glycine and then air, respectively. According to the statistical work, these fluids were found to have a significant effect on the measured impedance of the bladder tissue in benign and malignant areas. Furthermore, the best fluid between air, glycine and saline, to measure the impedance of the urinary bladder, is air (P<0.0001).

Electrical impedance spectroscopy and the diagnosis of bladder pathology

Bladder pathology is usually investigated visually by cystoscopy. At present, definitive diagnosis of the bladder can be made by biopsy only, usually under general anaesthesia. This is a relatively high-cost procedure in terms of both time and money and is associated with discomfort for the patient and morbidity. Thus, we used an electrical impedance spectroscopy technique for differentiating pathological changes in the urothelium and improving cystoscopic detection. For ex vivo study, a whole or part of the patient's urinary bladder was used to take the readings less than half an hour after excision at room temperature, about 27 degrees C, using the Mk3.5 Sheffield System (2-384 kHz in 24 frequencies). In this study, 145 points (from 16 freshly excised bladders from patients) were studied in terms of their biopsy reports matching to the electrical impedance measurements. For in vivo study, a total of 106 points from 38 patients were studied to take electrical impedance and biopsy samples. The impedance data were evaluated in both malignant and benign groups, and revealed a significant difference between these two groups. The impedivity of the malignant bladder tissue was significantly higher than the impedivity of the benign tissue, especially at lower frequencies (p < 0.001). In addition, the receiver operating characteristic (ROC) curve for impedance measurements indicated that this technique could provide diagnostic information (individual classification is possible). Thus, the authors have investigated the application of bio-impedance measurements to the bladder tissue as a novel and minimally invasive technique to characterize human bladder urothelium. Therefore, this technique, especially at lower frequencies, can be a complementary method for cystoscopy, biopsy and histopathological evaluation of the bladder abnormalities.

Electrical bioimpedance readings increase with higher pressure applied to the measuring probe

Electrical bioimpedance spectroscopy (EBIS) is a technique that uses a probe to calculate the transfer impedance from tissues. This transfer impedance can give information about the normal or pathological condition of the tissue. To take readings, pressure has to be applied to the probe in order to get a good contact between the electrodes and the tissue. We have been using EBIS to investigate the early diagnosis of dysplasia and cancer in the human cervix, oesophagus and bladder. We have found that, with increasing pressure (range used here was approximately 1 kPa to approximately 50 kPa), the resistivity readings increase in a consistent way up to 80%. In this paper, we show how this is a case in three different tissue types (oesophageal, gastric and vesical samples). These increases can be higher than those associated with the pathological changes that we are investigating (non-inflamed columnar tissue, for instance, shows values 50% higher than dysplastic columnar tissue). Finite-element modelling was also used to investigate the effect of volume reduction in the connective tissue or stroma. This simulation suggests no strong correlation between reduction of this structure and increase in resistivity. We hypothesize therefore that these changes may be mainly associated with the squeezing of water from the extracellular space. Finally, as pressure is difficult to control by hand, we raise the issue of the necessity of considering this variable when making EIS measurements.

Modelling the electrical properties of bladder tissue—quantifying impedance changes due to inflammation and oedema

Electrical impedance spectroscopy has been developed as a potential method for the diagnosis of carcinoma in epithelial tissues. An understanding of the influence of structural changes in the tissue on the properties measured using this technique is essential for interpreting measured data and optimization of probe design. In contrast to other tissue types, carcinoma in situ of the bladder gives rise to an increase in electrical impedance over the kHz-MHz frequency range in comparison to normal tissue. Finite element models of the urothelium and the underlying superficial lamina propria have been constructed and solved in order to ascertain the influence of structural changes associated with malignancy, oedema and inflammation on the measured electrical properties of the tissue. Sensitivity analysis of results from a composite tissue model suggests that the increase in lymphocyte density in the lamina propria associated with an inflammatory response to the infiltration of urine into the tissue may explain these unusual electrical properties.

Low frequency electrical bioimpedance for the detection of inflammation and dysplasia in Barrett's oesophagus

Biological tissues undergoing inflammation and dysplasia seem to exhibit changes in the intercellular space that can be sensed using low frequency electrical impedance methods. Basically, low frequency electric current flows through this space and its widening as well as the disruption of the tight junction decrease the resistance, facilitating current flow. The electrical changes accompanying structural changes from columnar tissue to adenocarcinoma in Barrett's metaplastic mucosa and gastric tissue are illustrated using resected tissue from 32 patients. Two hundred and fifty-eight biopsies were analysed, correlating their electrical resistivity (R) at 9.6 kHz and their histopathological interpretation. Compared to non-inflamed non-dysplastic columnar tissue (R = 4.9 ohms m), the results suggest a small but statistically significant decrease of electrical impedance in columnar tissue showing inflammation (R = 4.2 ohms m, p = 0.016) and a larger decrease when dysplasia is present (R = 3.4 ohms m, p = 0.040). If this method is validated further, this technique could be used to obtain guided biopsies from patients undergoing surveillance programmes for Barrett's oesophagus. We aim to refine this technique using a new system with lower frequencies and, possibly, in vitro (cultured cells) and in vivo (rats) models of Barrett's oesophagus.

Stand-off electrode (SoE): a new method for improving the sensitivity distribution of a tetrapolar probe

Tetrapolar probes have been widely used for measuring the impedance spectra of tissues. However, the non-uniform sensitivity distribution of these probes limits the ability to identify conductivity changes in tissue. This paper presents a novel method for improving the sensitivity distribution beneath a tetrapolar probe. The method consists of placing a hydrogel layer between the probe and the tissue in order to make the sensitivity positive everywhere within the tissue. Theoretical and measured sensitivity distributions are compared. A good agreement between theoretical and measured data from an electrolytic tank was obtained with a maximum error of 1.3%. In vivo forearm measurements showed that the use of a conductive layer does enable tissue conductivity spectra to be determined. A smaller variation between subjects was obtained when using the stand-off. It was not possible to assess the absolute accuracy of the method due to the absence of a 'gold standard' for the measurement of tissue conductivity spectra.

Modelling of epithelial tissue impedance measured using three different designs of probe

Impedance measurement is a promising technique for detecting pre-malignant changes in epithelial tissue. This paper considers how the design of the impedance probe affects the ability to discriminate between tissue types. To do this, finite element models of the electrical properties of squamous and glandular columnar epithelia have been used. The glandular tissue model is described here for the first time. Glandular mucosa is found in many regions of the gastrointestinal tract, such as the stomach and intestine, and has a large effective surface area. Firstly, the electrical properties of a small section of gland, with epithelial cells and supportive tissue, are determined. These properties are then used to build up a three-dimensional model of a whole section of mucosa containing many thousands of glands. Measurements using different types of impedance probe were simulated by applying different boundary conditions to the models. Transepithelial impedance, and tetrapolar measurement with a probe placed on the tissue surface have been modelled. In the latter case, the impedance can be affected by conductive fluid, such as mucus, on the tissue surface. This effect has been investigated, and a new design of probe, which uses a guard electrode to counteract this potential source of variability, is proposed.

Electrical impedance spectroscopy and the diagnosis of bladder pathology: a pilot study

PURPOSE

Carcinoma in situ is an aggressive form of bladder cancer with a high propensity for invasion if left untreated. On cystoscopy these flat lesions cannot be differentiated from other erythematous, potentially benign areas and they require biopsy for definitive diagnosis. Other methods of detecting carcinoma in situ remain experimental. We assessed the effectiveness of electrical impedance spectroscopy, a method that measures the variation of electrical current flow with frequency through the mucosa, for differentiating various pathological changes in the urothelium.

MATERIALS AND METHODS

We obtained 250 impedance measurements immediately after resection in 35 cystectomy specimens using a custom designed probe. Three consecutive readings were recorded per point to assess reproducibility and punch biopsy was done at the measurement site.

RESULTS

Changes in the urothelium were classified histologically into 7 subgroups according to the degree of edema and inflammation. Electrical impedance spectroscopy measurements were able to separate benign and malignant changes when tested as a group (p <0.001), although some individual points overlapped. Edema also had a significant effect on tissue impedance (p <0.001).

CONCLUSIONS

Using measurements we established patterns of electrical impedance in the human bladder. Early results suggest that this minimally invasive technique is able to differentiate benign and malignant bladder pathologies. However, it requires further refinement and evaluation at lower frequencies, where the greatest impedance difference in benign and malignant tissues is expected.

Electrical impedance spectroscopy and the diagnosis of bladder pathology: a pilot study

PURPOSE

Carcinoma in situ is an aggressive form of bladder cancer with a high propensity for invasion if left untreated. On cystoscopy these flat lesions cannot be differentiated from other erythematous, potentially benign areas and they require biopsy for definitive diagnosis. Other methods of detecting carcinoma in situ remain experimental. We assessed the effectiveness of electrical impedance spectroscopy, a method that measures the variation of electrical current flow with frequency through the mucosa, for differentiating various pathological changes in the urothelium.

MATERIALS AND METHODS

We obtained 250 impedance measurements immediately after resection in 35 cystectomy specimens using a custom designed probe. Three consecutive readings were recorded per point to assess reproducibility and punch biopsy was done at the measurement site.

RESULTS

Changes in the urothelium were classified histologically into 7 subgroups according to the degree of edema and inflammation. Electrical impedance spectroscopy measurements were able to separate benign and malignant changes when tested as a group (p <0.001), although some individual points overlapped. Edema also had a significant effect on tissue impedance (p <0.001).

CONCLUSIONS

Using measurements we established patterns of electrical impedance in the human bladder. Early results suggest that this minimally invasive technique is able to differentiate benign and malignant bladder pathologies. However, it requires further refinement and evaluation at lower frequencies, where the greatest impedance difference in benign and malignant tissues is expected.

Electrical impedance spectroscopy (EIS) in the urinary bladder: the effect of inflammation and edema on identification of malignancy

Previous studies have shown that tetrapolar electrical impedance spectroscopy measurements can identify cervical interstitial neoplasia with the same sensitivity and specificity as cervical smears. In the urinary bladder, the same technique yields significant differences (p < 0.05 at seven frequencies between 9.6 and 614 kHz) between normal and malignant urothelium, but is unable to classify individual measurements. Detailed histological examination demonstrates that inflammation and edema--both of which are common in abnormal urothelium--alter the impedance spectrum significantly in opposing directions. Consideration of morphological changes in abnormal urothelium suggests alternative measurement strategies.

Resistivity changes in conductive silicone sheets under stretching

This paper reports a preliminary finding associated with an investigation of how tissues respond to mechanical stress. The stress distribution within the tissue may be the result of normal function, for example, joint forces, or it may result from interventions such as tissue suturing during or after surgery. We sought to combine electrical and mechanical computational models in order to better understand the interaction between the two. For example, if mechanical stress is applied to tissue this may change the cell arrangements within the tissue matrix and hence change the electrical properties. If this interaction could be determined, then it should be possible to use electrical impedance tomography measurements to identify stress patterns in tissues. Measurements of resistivity changes have been made in conductive silicone rubber sheets when subject to a uniaxial stress of up to 10%. Relatively large changes in resistivity are produced (up to 200%). These changes are far larger than those predicted arising from topological changes alone. It is suggested that under stress the conductive islands of carbon within the silicone rubber sheet undergo a reversible disassociation from their neighbours and that the material's electrical properties change under load. If similar stress-resistivity relationships occur within biological materials it may be possible to recover the stress fields within tissues from transfer impedance measurements and thereby predict if actions such as inappropriate suture tension will compromise tissue viability.

Assessing the conditions for in vivo electrical virtual biopsies in Barrett's oesophagus

It has previously been shown that it is possible to differentiate between squamous and columnar epithelia in rat and resected human tissues using an impedance probe to make in vitro measurements. This probe can be passed down an endoscope allowing measurements to be made in patients. However, the probe emerges parallel to the oesophageal wall, with little room to manoeuvre. The conditions of control required to give reliable readings have been investigated. The importance of pressure applied and the angle of approach to the oesophagus was assessed. Pressures in the range 26.6 Pa to 46.3 kPa and angles in the range 15-90 degrees were considered. In in vitro studies it was observed that it was possible to obtain consistent readings with pressures greater than 2.9 kPa and with angles greater than 15 degrees between the probe and the oesophagus. These conditions can be achieved in vivo, and readings obtained from twelve patients are shown (45 readings on normal squamous, 34 on Barrett's oesophagus and 22 on stomach). At low frequencies (9.6-153.2 kHz), a Mann-Whitney test shows a significant difference (p < 0.001) when comparing the means from squamous and columnar, and also when readings from Barrett's and normal gastric epithelia are compared (p < 0.001).