Design and validation of an angle-resolved low-coherence interferometry fiber probe for in vivo clinical measurements of depth-resolved nuclear morphology

Recovery of angular scattering profiles through a flexible multimode fiber

Endoscopic angle-resolved light scattering methods have been developed for early cancer detection but they typically require multi-element coherent fiber optic bundles to recover scattering distributions from tissues. Recent work has focused on using a single multimode fiber (MMF) to measure angle resolved scattering but this approach has practical limitations to overcome before clinical translation. Here we address these limitations by proposing an MMF-based endoscope capable of measuring angular scattering patterns suitable for determining structure. Significantly, this approach implements a spectrally resolved detection scheme to reduce speckle and leverages the azimuthal symmetry of the angular scattering patterns to enable measurements that are robust to fiber bending. This results in a unique method that does not require matrix inversion or machine learning to measure a transmitted scattering distribution. The MMF utilized here is 1000 mm in length with a 200 µm core and is demonstrated to recover angular scattering distributions even with bending displacements of up to 30 cm. This advance has a significant impact on the clinical translation of biomedical endoscopic diagnostic techniques that use angular scattering to determine the size of cell nuclei to detect early cancer.

Next-generation endoscopic probe for detection of esophageal dysplasia using combined OCT and angle-resolved low-coherence interferometry

Angle-resolved low-coherence interferometry (a/LCI) is an optical technique that enables depth-specific measurements of nuclear morphology, with applications to detecting epithelial cancers in various organs. Previous a/LCI setups have been limited by costly fiber-optic components and large footprints. Here, we present a novel a/LCI instrument incorporating a channel for optical coherence tomography (OCT) to provide real-time image guidance. We showcase the system's capabilities by acquiring imaging data from in vivo Barrett's esophagus patients. The main innovation in this geometry lies in implementing a pathlength-matched single-mode fiber array, offering substantial cost savings while preserving signal fidelity. A further innovation is the introduction of a specialized side-viewing probe tailored for esophageal imaging, featuring miniature optics housed in a custom 3D-printed enclosure attached to the tip of the endoscope. The integration of OCT guidance enhances the precision of tissue targeting by providing real-time morphology imaging. This novel device represents a significant advancement in clinical translation of an enhanced screening approach for esophageal precancer, paving the way for more effective early-stage detection and intervention strategies.

Optical coherence tomography of small intestine allograft biopsies using a handheld surgical probe

SIGNIFICANCE

The current gold standard for monitoring small intestinal transplant (IT) rejection is endoscopic visual assessment and biopsy of suspicious lesions; however, these lesions are only superficially visualized by endoscopy. Invasive biopsies provide a coarse sampling of tissue health without depicting the true presence and extent of any pathology. Optical coherence tomography (OCT) presents a potential alternative approach with significant advantages over traditional white-light endoscopy.

AIM

The aim of our investigation was to evaluate OCT performance in distinguishing clinically relevant morphological features associated with IT graft failure.

APPROACH

OCT was applied to evaluate the small bowel tissues of two rhesus macaques that had undergone IT of the ileum. The traditional assessment from routine histological observation was compared with OCT captured using a handheld surgical probe during the days post-transplant and subsequently was compared with histophaology.

RESULTS

The reported OCT system was capable of identifying major biological landmarks in healthy intestinal tissue. Following IT, one nonhuman primate (NHP) model suffered a severe graft ischemia, and the second NHP graft failed due to acute cellular rejection. OCT images show visual evidence of correspondence with histological signs of IT rejection.

CONCLUSIONS

Results suggest that OCT imaging has significant potential to reveal morphological changes associated with IT rejection and to improve patient outcomes overall.

Deep learning classification of cervical dysplasia using depth-resolved angular light scattering profiles

We present a machine learning method for detecting and staging cervical dysplastic tissue using light scattering data based on a convolutional neural network (CNN) architecture. Depth-resolved angular scattering measurements from two clinical trials were used to generate independent training and validation sets as input of our model. We report 90.3% sensitivity, 85.7% specificity, and 87.5% accuracy in classifying cervical dysplasia, showing the uniformity of classification of a/LCI scans across different instruments. Further, our deep learning approach significantly improved processing speeds over the traditional Mie theory inverse light scattering analysis (ILSA) method, with a hundredfold reduction in processing time, offering a promising approach for a/LCI in the clinic for assessing cervical dysplasia.

A review of low-cost and portable optical coherence tomography

Optical coherence tomography (OCT) is a powerful optical imaging technique capable of visualizing the internal structure of biological tissues at near cellular resolution. For years, OCT has been regarded as the standard of care in ophthalmology, acting as an invaluable tool for the assessment of retinal pathology. However, the costly nature of most current commercial OCT systems has limited its general accessibility, especially in low-resource environments. It is therefore timely to review the development of low-cost OCT systems as a route for applying this technology to population-scale disease screening. Low-cost, portable and easy to use OCT systems will be essential to facilitate widespread use at point of care settings while ensuring that they offer the necessary imaging performances needed for clinical detection of retinal pathology. The development of low-cost OCT also offers the potential to enable application in fields outside ophthalmology by lowering the barrier to entry. In this paper, we review the current development and applications of low-cost, portable and handheld OCT in both translational and research settings. Design and cost-reduction techniques are described for general low-cost OCT systems, including considerations regarding spectrometer-based detection, scanning optics, system control, signal processing, and the role of 3D printing technology. Lastly, a review of clinical applications enabled by low-cost OCT is presented, along with a detailed discussion of current limitations and outlook.

Novel endoscopic optical diagnostic technologies in medical trial research: recent advancements and future prospects

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.

Prospective detection of cervical dysplasia with scanning angle-resolved low coherence interferometry

We present a prospective clinical study using angle-resolved low-coherence interferometry (a/LCI) to detect cervical dysplasia via depth resolved nuclear morphology measurements. The study, performed at the Jacobi Medical Center, compares 80 a/LCI optical biopsies taken from 20 women with histopathological tissue diagnosis of co-registered physical biopsies. A novel instrument was used for this study that enables 2D scanning across the cervix without repositioning the probe. The main study goal was to compare performance with a previous clinical a/LCI point-probe instrument [Int. J. Cancer140, 1447 (2017)] and use the same diagnostic criteria as in that study. Tissue was classified in two schemes: non-dysplastic vs. dysplastic and low-risk vs. high-risk, with the latter classification aligned with clinically actionable diagnosis. High sensitivity (non-dysplastic vs. dysplastic: 0.903, low-risk vs. high-risk: 1.000) and NPV (0.930 and 1.000 respectively) were obtained when using the previously established decision boundaries, showing the success of the scanning a/LCI instrument and reinforcing the clinical viability of a/LCI in disease detection.

Reconstruction of angle-resolved backscattering through a multimode fiber for cell nuclei and particle size determination

We demonstrate reconstruction of angle-resolved optical backscattering after transmission through a multimode fiber. Angle-resolved backscattering is an important tool for particle sizing, and has been developed as a diagnostic modality for detecting epithelial precancer. In this work, we fully characterized the transfer function of a multimode fiber using a plane-wave illumination basis across two dimensions. Once characterized, angle-resolved scattering information which has been scrambled by multimodal propagation can be easily and accurately reconstructed. Our technique was validated using a Mie theory-based inverse light scattering analysis (ILSA) algorithm on polystyrene microsphere phantoms of known sizes. To demonstrate the clinical potential of this approach, nuclear morphology was determined from the reconstructed angular backscattering from MCF-10A human mammary epithelial cell samples and validated against quantitative image analysis (QIA) of fluorescence microscopy images.

Optical coherence tomography through a rigid borescope applied to quantification of articular cartilage thickness in a porcine knee model

There exists an unmet need for an optical coherence tomography (OCT) delivery scheme that is simple, robust, and applicable to general surgical applications. To deliver the beam in a narrow form factor, optical borescopes present an attractive potential solution. We present a method for enabling endoscopic delivery of OCT using a handheld rigid borescope adapted to a low-cost OCT engine. The system reduces the distal profile of the scanner, enabling application of the system in otherwise hard-to-access regions. The clinical potential of this design is demonstrated through real-time quantification of articular cartilage thickness, a primary biomarker of joint health during osteoarthritis. This platform has the potential to enable use of OCT for real-time feedback during arthroscopic surgery.

Optimized light delivery probe using ball lenses for co-registered photoacoustic and ultrasound endo-cavity subsurface imaging

An optimized hand-held photoacoustic and ultrasound probe suitable for endo-cavity tumor subsurface imaging was designed and evaluated. Compared to previous designs, the prototype probe, consisting of four 1 mm multi-mode optical fibers attached with 1.5 mm diameter ball-shaped fiber tips sandwiched between a transvaginal ultrasound transducer and a custom-made sheath, demonstrated a higher light output and better beam homogeneity on tissue subsurface. The output power and fluence profile were simulated for different design parameters. A camera recorded fluence profiles through calibrated intralipid solution at various imaging depths. The light delivery efficiency was experimentally compared with and without the ball lenses, based on ex-vivo imaging of human colorectal cancer and in-vivo imaging of a palmar vein proximal to the human wrist. The simulations and experiments demonstrated that ball-shaped fiber tip design can achieve homogeneous fluence distribution on tissue subsurface with acceptable light output efficiency, suggesting its clinical potential for in-vivo endo-cavity imaging.

Response to Comment on "Is the nuclear refractive index lower than cytoplasm? Validation of phase measurements and implications for light scattering technologies": A Comment on "How a phase image of a cell with nucleus refractive index smaller than that of the cytoplasm should look like?", e201800033

Recently, Maxim A. Yurkin commented on our paper "Is the nuclear refractive index lower than cytoplasm? Validation of phase measurements and implications for light scattering technologies" as well as on a complementary study "Cell nuclei have lower refractive index and mass density than cytoplasm" from Schürmann et al. In his comment, Yurkin concluded that quantitative phase images of cells with nuclei that are less optically dense than the cytoplasm must exhibit a characteristic concavity, the absence of which is evidence against our conclusion of a less-dense nucleus. In this response, we suggest that Yurkin's conclusion is reached through an oversimplification of the spatial refractive index distribution within cells, which does not account for high index inclusions such as the nucleolus. We further cite recent studies in 3-dimensional refractive index imaging, in which the preponderance of studies supports our conclusion. Finally, we comment on the current state of knowledge regarding subcellular refractive index distributions in living cells.

Beyond backscattering: optical neuroimaging by BRAD

Optical coherence tomography (OCT) is a powerful technology for rapid volumetric imaging in biomedicine. The bright field imaging approach of conventional OCT systems is based on the detection of directly backscattered light, thereby waiving the wealth of information contained in the angular scattering distribution. Here we demonstrate that the unique features of few-mode fibers (FMF) enable simultaneous bright and dark field (BRAD) imaging for OCT. As backscattered light is picked up by the different modes of a FMF depending upon the angular scattering pattern, we obtain access to the directional scattering signatures of different tissues by decoupling illumination and detection paths. We exploit the distinct modal propagation properties of the FMF in concert with the long coherence lengths provided by modern wavelength-swept lasers to achieve multiplexing of the different modal responses into a combined OCT tomogram. We demonstrate BRAD sensing for distinguishing differently sized microparticles and showcase the performance of BRAD-OCT imaging with enhanced contrast for ex vivo tumorous tissue in glioblastoma and neuritic plaques in Alzheimer's disease.

Spatially resolved diffuse reflectance spectroscopy endoscopic sensing with custom Si photodetectors

Early detection and surveillance of disease progression in epithelial tissue is key to improving long term patient outcomes for colon and esophageal cancers, which account for nearly a quarter of cancer related mortalities worldwide. Spatially resolved diffuse reflectance spectroscopy (SRDRS) is a non-invasive optical technique to sense biological changes at the cellular and sub-cellular level that occur when normal tissue becomes diseased, and has the potential to significantly improve the current standard of care for endoscopic gastrointestinal (GI) screening. Herein the design, fabrication, and characterization of the first custom SRDRS device to enable endoscopic SRDRS GI tissue characterization using a custom silicon (Si) thin film multi-pixel endoscopic optical sensor (MEOS) is described.

Comparison of imaging fiber bundles for coherence-domain imaging

Use of imaging fiber bundles for coherence-domain imaging has remained limited to date. In this work, we provide characterization of commercially available imaging bundles for coherence-domain imaging, by evaluating their modal structure for applicability to interferometric imaging. We further examine custom fabricated bundles developed in collaboration with a corporate partner for their ability to reduce interelement optical path length variability and cross talk between elements. The results presented here will serve as a useful guide for comparing fiber bundles for coherence imaging while also offering an improved understanding of the functionality and limitations of imaging bundles for advancing coherent imaging technologies.

Scanning system for angle-resolved low-coherence interferometry

Angle-resolved low-coherence interferometry (a/LCI) detects precancer by enabling depth-resolved measurements of nuclear morphology in vivo. A significant limitation of a/LCI is the point-probe nature of the method, sampling <0.5  mm² before probe relocation is necessary. In this work, we demonstrate a scanning method capable of assessing an area >100  mm² without repositioning. By utilizing a reflection-only three-optic rotator prism and a two-axis scanning mirror, we demonstrate radial scans of a sample with a linear range of 12 mm and a full rotational range of 180°. Use of this design will improve the diagnostic utility of a/LCI for wide-area screening of tissue health.

Feasibility of clinical detection of cervical dysplasia using angle-resolved low coherence interferometry measurements of depth-resolved nuclear morphology

This study sought to establish the feasibility of using in situ depth-resolved nuclear morphology measurements for detection of cervical dysplasia. Forty enrolled patients received routine cervical colposcopy with angle-resolved low coherence interferometry (a/LCI) measurements of nuclear morphology. a/LCI scans from 63 tissue sites were compared to histopathological analysis of co-registered biopsy specimens which were classified as benign, low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL). Results were dichotomized as dysplastic (LSIL/HSIL) versus non-dysplastic and HSIL versus LSIL/benign to determine both accuracy and potential clinical utility of a/LCI nuclear morphology measurements. Analysis of a/LCI data was conducted using both traditional Mie theory based processing and a new hybrid algorithm that provides improved processing speed to ascertain the feasibility of real-time measurements. Analysis of depth-resolved nuclear morphology data revealed a/LCI was able to detect a significant increase in the nuclear diameter at the depth bin containing the basal layer of the epithelium for dysplastic versus non-dysplastic and HSIL versus LSIL/Benign biopsy sites (both p < 0.001). Both processing techniques resulted in high sensitivity and specificity (>0.80) in identifying dysplastic biopsies and HSIL. The hybrid algorithm demonstrated a threefold decrease in processing time at a slight cost in classification accuracy. The results demonstrate the feasibility of using a/LCI as an adjunctive clinical tool for detecting cervical dysplasia and guiding the identification of optimal biopsy sites. The faster speed from the hybrid algorithm offers a promising approach for real-time clinical analysis.

Endoscopic optical coherence tomography: technologies and clinical applications [Invited]

In this paper, we review the current state of technology development and clinical applications of endoscopic optical coherence tomography (OCT). Key design and engineering considerations are discussed for most OCT endoscopes, including side-viewing and forward-viewing probes, along with different scanning mechanisms (proximal-scanning versus distal-scanning). Multi-modal endoscopes that integrate OCT with other imaging modalities are also discussed. The review of clinical applications of endoscopic OCT focuses heavily on diagnosis of diseases and guidance of interventions. Representative applications in several organ systems are presented, such as in the cardiovascular, digestive, respiratory, and reproductive systems. A brief outlook of the field of endoscopic OCT is also discussed.

Evaluation of hybrid algorithm for analysis of scattered light using ex vivo nuclear morphology measurements of cervical epithelium

We evaluate a new hybrid algorithm for determining nuclear morphology using angle-resolved low coherence interferometry (a/LCI) measurements in ex vivo cervical tissue. The algorithm combines Mie theory based and continuous wavelet transform inverse light scattering analysis. The hybrid algorithm was validated and compared to traditional Mie theory based analysis using an ex vivo tissue data set. The hybrid algorithm achieved 100% agreement with pathology in distinguishing dysplastic and non-dysplastic biopsy sites in the pilot study. Significantly, the new algorithm performed over four times faster than traditional Mie theory based analysis.

Co-localized confocal Raman spectroscopy and optical coherence tomography (CRS-OCT) for depth-resolved analyte detection in tissue

We report the development of a combined confocal Raman spectroscopy (CRS) and optical coherence tomography (OCT) instrument (CRS-OCT) capable of measuring analytes in targeted biological tissues with sub-100-micron spatial resolution. The OCT subsystem was used to measure depth-resolved tissue morphology and guide the acquisition of chemically-specific Raman spectra. To demonstrate its utility, the instrument was used to accurately measure depth-resolved, physiologically-relevant concentrations of Tenofovir, a microbicide drug used to prevent the sexual transmission of HIV, in ex vivo tissue samples.

Noise characterization of supercontinuum sources for low-coherence interferometry applications

We examine the noise properties of supercontinuum light sources when used in low-coherence interferometry applications. The first application is a multiple-scattering low-coherence interferometry (ms2/LCI) system, where high power and long image acquisition times are required to image deep into tissue. For this system, we compare the noise characteristics of two supercontinuum sources from different suppliers. Both sources have long-term drift that limits the amount of time over which signal averaging is advantageous for reducing noise. The second application is a high-resolution optical coherence tomography system, where broadband light is needed for high axial resolution. For this system, we compare the noise performance of the two supercontinuum sources and a light source based on four superluminescent diodes (SLD) using imaging contrast as a comparative metric. We find that the NKT SuperK has superior noise performance compared with the Fianium SC-450-4, but neither meets the performance of the SLD.

Wavelet transform fast inverse light scattering analysis for size determination of spherical scatterers

We present a fast approach for size determination of spherical scatterers using the continuous wavelet transform of the angular light scattering profile to address the computational limitations of previously developed sizing techniques. The potential accuracy, speed, and robustness of the algorithm were determined in simulated models of scattering by polystyrene beads and cells. The algorithm was tested experimentally on angular light scattering data from polystyrene bead phantoms and MCF-7 breast cancer cells using a 2D a/LCI system. Theoretical sizing of simulated profiles of beads and cells produced strong fits between calculated and actual size (r(2) = 0.9969 and r(2) = 0.9979 respectively), and experimental size determinations were accurate to within one micron.

Numerical investigation of two-dimensional light scattering patterns of cervical cell nuclei to map dysplastic changes at different epithelial depths

We use an extensive set of quantitative histopathology data to construct realistic three-dimensional models of normal and dysplastic cervical cell nuclei at different epithelial depths. We then employ the finite-difference time-domain method to numerically simulate the light scattering response of these representative models as a function of the polar and azimuthal scattering angles. The results indicate that intensity and shape metrics computed from two-dimensional scattering patterns can be used to distinguish between different diagnostic categories. Our numerical study also suggests that different epithelial layers and angular ranges need to be considered separately to fully exploit the diagnostic potential of two-dimensional light scattering measurements.

Fourier domain multispectral multiple scattering low coherence interferometry

We have implemented multispectral multiple scattering low coherence interferometry (ms2/LCI) with Fourier domain data collection. The ms2/LCI system is designed to localize features with spectroscopic contrast with millimeter resolution up to 1 cm deep in scattering samples by using photons that have undergone multiple low-angle (forward) scattering events. Fourier domain detection both increases the data acquisition speed of the system and gives access to rich spectroscopic information, compared to the previous single channel, time-domain implementation. Separate delivery and detection angular apertures reduce collection of the diffuse background signal in order to isolate localized spectral features from deeper in scattering samples than would be possible with traditional spectroscopic optical coherence tomography. Light from a supercontinuum source is used to acquire absorption spectra of chromophores in the visible range within a tissue-like scattering phantom. An intensity modulation and digital lock-in detection scheme is implemented to mitigate relative intensity and spectral noise inherent in supercontinuum sources. The technical parameters of the system and comparative analysis are presented.

Advances in optical adjunctive AIDS for visualisation and detection of oral malignant and potentially malignant lesions

Traditional methods of screening for oral potentially malignant disorders and oral malignancies involve a conventional oral examination with digital palpation. Evidence indicates that conventional examination is a poor discriminator of oral mucosal lesions. A number of optical aids have been developed to assist the clinician to detect oral mucosal abnormalities and to differentiate benign lesions from sinister pathology. This paper discusses advances in optical technologies designed for the detection of oral mucosal abnormalities. The literature regarding such devices, VELscope and Identafi, is critically analysed, and the novel use of Narrow Band Imaging within the oral cavity is also discussed. Optical aids are effective in assisting with the detection of oral mucosal abnormalities; however, further research is required to evaluate the usefulness of these devices in differentiating benign lesions from potentially malignant and malignant lesions.

A scattering phantom for observing long range order with two-dimensional angle-resolved Low-Coherence Interferometry

Angle-resolved low coherence interferometry (a/LCI) is an approach for assessing tissue structure based on light scattering data. Recent advances in a/LCI have extended the analysis to study scattering distributions in two dimensions. In order to provide suitable scattering phantoms for 2D a/LCI, we have developed phantoms based on soft lithography which can provide a range of structures including long range order. Here we characterize these phantoms and demonstrate their utility for providing standardized multi-scale structural information for light scattering measurements.

Sapphire ball lensed fiber probe for common-path optical coherence tomography in ocular imaging and sensing

We describe a novel common-path optical coherence tomography (CP-OCT) fiber probe design using a sapphire ball lens for cross-sectional imaging and sensing in retina vitrectomy surgery. Single mode Gaussian beam (TEM00) simulation was used to optimize lateral resolution and working distance (WD) of the common-path probe. A theoretical sensitivity model for CP-OCT was prosed to assess its optimal performance based an unbalanced photodetector configuration. Two probe designs with working distances (WD) 415μm and 1221μm and lateral resolution 11μm and 18μm, respectively were implemented with sensitivity up to 88dB. The designs are also fully compatible with conventional Michelson interferometer based OCT configurations. The reference plane of the probe, located at the distal beam exit interface of the single mode fiber (SMF), was encased within a 25-gauge hypodermic needle by the sapphire ball lens facilitates its applications in bloody and harsh environments. The performances of the fiber probe with 11μm of lateral resolution and 19μm of axial resolution were demonstrated by cross-sectional imaging of a cow cornea and retina in vitro with a 1310nm swept source OCT system. This probe was also attached to a piezoelectric motor for active compensation of physiological tremor for handheld retinal surgical tools.

Radial angular filter arrays for angle-resolved scattering spectroscopy

The radial angular filter array (RAFA) consists of a series of radially-distributed micro-machined channels, where the long axes of the channels converge at a focal point. The high aspect ratio of each channel provides a means to reject photons with trajectories outside the acceptance angle of the channel. The output of the RAFA represents the angular distribution of photons emitted from the focal point. A series of RAFAs were designed, fabricated, and tested to evaluate the impact of device geometry, inter-channel cross talk, achromaticity, and channel leakage on device performance. As an application example, an RAFA was used together with an imaging spectrometer to capture angle-resolved spectra of turbid samples.

Sapphire ball lens-based fiber probe for common-path optical coherence tomography and its applications in corneal and retinal imaging

We describe a common-path swept source optical coherence tomography fiber probe design using a sapphire ball lens for cross-sectional imaging and sensing for retina vitrectomy surgery. The high refractive index (n=1.75) of the sapphire ball lens improves the focusing power and enables the probe to operate in the intraocular space. The highly precise spherical shape of the sapphire lens also reduces astigmatism and coma compared to fused nonspherical ball lenses. A theoretical sensitivity model for common-path optical coherence tomography (CP-OCT) was developed to assess its optimal performance based on an unbalanced photodetector configuration. Two probe designs-with working distances 415 and 1221 μm and lateral resolution 11 and 18 μm-were implemented with sensitivity up to 88 dB, which is significantly higher than previously reported CP-OCT probes. We assessed the performances of the fiber probes by cross-sectional imaging a bovine cornea and retina in air and in vitreous gel with a 1310 nm swept source OCT system. To the best of our knowledge, this is the first demonstration of sapphire ball lens-based CP-OCT probes directly inserted into the vitreous gel of a bovine eyeball for ocular imaging with a sensitivity approaching the theoretical limitation of CP-OCT.

Angle-resolved low-coherence interferometry: an optical biopsy technique for clinical detection of dysplasia in Barrett's esophagus

Angle-resolved low-coherence interferometry (a/LCI) is an optical biopsy technique that measures scattered light from tissue to determine nuclear size with submicron-level accuracy. The a/LCI probe can be deployed through the accessory channel of a standard endoscope and provides feedback to physicians to guide physical biopsies. The technique has been validated in animal and ex vivo human studies, and has been used to detect dysplasia in Barrett's esophagus patients in vivo. In a recent clinical study of 46 Barrett's esophagus patients, a/LCI was able to detect dysplasia with 100% sensitivity and 84% specificity. This report reviews the technique and discusses its potential clinical utility.

Detection of intestinal dysplasia using angle-resolved low coherence interferometry

Angle-resolved low coherence interferometry (a/LCI) is an optical biopsy technique that allows for depth-resolved, label-free measurement of the average size and optical density of cell nuclei in epithelial tissue to assess the tissue health. a/LCI has previously been used clinically to identify the presence of dysplasia in Barrett's Esophagus patients undergoing routine surveillance. We present the results of a pilot, ex vivo study of tissues from 27 patients undergoing partial colonic resection surgery, conducted to evaluate the ability of a/LCI to identify dysplasia. Performance was determined by comparing the nuclear morphology measurements with pathological assessment of co-located physical biopsies. A statistically significant correlation between increased average nuclear size, reduced nuclear density, and the presence of dysplasia was noted at the basal layer of the epithelium, at a depth of 200 to 300 μm beneath the tissue surface. Using a decision line determined from a receiver operating characteristic, a/LCI was able to separate dysplastic from healthy tissues with a sensitivity of 92.9% (13/14), a specificity of 83.6% (56/67), and an overall accuracy of 85.2% (69/81). The study illustrates the extension of the a/LCI technique to the detection of intestinal dysplasia, and demonstrates the need for future in vivo studies.

Development of angle-resolved low coherence interferometry for clinical detection of dysplasia

This review covers the development of angle-resolved low coherence interferometry (a/LCI) from initial development through clinical application. In the first applications, the approach used a time-domain interferometry scheme and was validated using animal models of carcinogenesis to assess the feasibility of detecting dysplasia in situ. Further development of the approach led to Fourier-domain interferometry schemes with higher throughput and endoscope-compatible probes to enable clinical application. These later implementations have been applied to clinical studies of dysplasia in Barrett's esophagus tissues, a metaplastic tissue type that is associated with an increased risk of esophageal adenocarcinoma. As an alternative to systematic biopsy, the a/LCI approach offers high sensitivity and specificity for detecting dysplasia in these tissues while avoiding the need for tissue removal or exogenous contrast agents. Here, the various implementations of a/LCI are discussed and the results of the preliminary animal experiments and ex vivo human tissue studies are reviewed. A review of a recent in vivo clinical study is also presented.

Detection of dysplasia in Barrett's esophagus with in vivo depth-resolved nuclear morphology measurements

BACKGROUND & AIMS

Patients with Barrett's esophagus (BE) show increased risk of developing esophageal adenocarcinoma and are routinely examined using upper endoscopy with biopsy to detect neoplastic changes. Angle-resolved low coherence interferometry (a/LCI) uses in vivo depth-resolved nuclear morphology measurements to detect dysplasia. We assessed the clinical utility of a/LCI in the endoscopic surveillance of patients with BE.

METHODS

Consecutive patients undergoing routine surveillance upper endoscopy for BE were recruited at 2 endoscopy centers. A novel, endoscope-compatible a/LCI system measured the mean diameter and refractive index of cell nuclei in esophageal epithelium at 172 biopsy sites in 46 patients. At each site, an a/LCI measurement was correlated with a concurrent endoscopic biopsy specimen. Each biopsy specimen was assessed histologically and classified as normal, nondysplastic BE, indeterminate for dysplasia, low-grade dysplasia (LGD), or high-grade dysplasia (HGD). The a/LCI data from multiple depths were analyzed to evaluate its ability to differentiate dysplastic from nondysplastic tissue.

RESULTS

Pathology characterized 5 of the scanned sites as HGD, 8 as LGD, 75 as nondysplastic BE, 70 as normal tissue types, and 14 as indeterminate for dysplasia. The a/LCI nuclear size measurements separated dysplastic from nondysplastic tissue at a statistically significant (P < .001) level for the tissue segment 200 to 300 μm beneath the surface with an accuracy of 86% (147/172). A receiver operator characteristic analysis indicated an area under the curve of 0.91, and an optimized decision point gave 100% (13/13) sensitivity and 84% (134/159) specificity.

CONCLUSIONS

These preliminary data suggest a/LCI is accurate in detecting dysplasia in vivo in patients with BE.

Fiber-optic interferometric two-dimensional scattering-measurement system

We present a fiber-optic interferometric system for measuring depth-resolved scattering in two angular dimensions using Fourier-domain low-coherence interferometry. The system is a unique hybrid of the Michelson and Sagnac interferometer topologies. The collection arm of the interferometer is scanned in two dimensions to detect angular scattering from the sample, which can then be analyzed to determine the structure of the scatterers. A key feature of the system is the full control of polarization of both the illumination and the collection fields, allowing for polarization-sensitive detection, which is essential for two-dimensional angular measurements. System performance is demonstrated using a double-layer microsphere phantom. Experimental data from samples with different sizes and acquired with different polarizations show excellent agreement with Mie theory, producing structural measurements with subwavelength accuracy.