1
|
Cordoba A. Brain Tumor Anatomy with Tractography Fluorescence and Confocal Endoscopy. Adv Tech Stand Neurosurg 2024; 52:7-19. [PMID: 39017783 DOI: 10.1007/978-3-031-61925-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Tractography fluorescence and confocal endomicroscopy are complementary technologies to targeted tumor resection, and it is certain that as our technology for fluorescent probes continues to evolve, the confocal microscope will continue to be refined. Recent work suggests that intraoperative high-resolution augmented reality endomicroscopy, a real-time alternative to invasive biopsy and histopathology, has the potential to better quantify tumor burden at the final stages of surgery and ultimately to improve patient outcomes when combined with wide-field imaging approaches. Additional studies are needed to further elucidate the clinical benefits of these new technologies for brain tumor patients.
Collapse
|
2
|
Xiang F, Yu J, Jiang D, Hu W, Zhang R, Huang C, Wu T, Gao Y, Zheng A, Liu TM, Zheng W, Li X, Li H. Quantitative multiphoton imaging of cell metabolism, stromal fibers, and keratinization enables label-free discrimination of esophageal squamous cell carcinoma. BIOMEDICAL OPTICS EXPRESS 2023; 14:4137-4155. [PMID: 37799684 PMCID: PMC10549756 DOI: 10.1364/boe.492109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/02/2023] [Accepted: 06/29/2023] [Indexed: 10/07/2023]
Abstract
Esophageal squamous cell carcinoma (ESCC) features atypical clinical manifestations and a low 5-year survival rate (< 5% in many developing countries where most of the disease occurs). Precise ESCC detection and grading toward timely and effective intervention are therefore crucial. In this study, we propose a multidimensional, slicing-free, and label-free histopathological evaluation method based on multispectral multiphoton fluorescence lifetime imaging microscopy (MM-FLIM) for precise ESCC identification. To assess the feasibility of this method, comparative imaging on fresh human biopsy specimens of different ESCC grades is performed. By constructing fluorescence spectrum- and lifetime-coded images, ESCC-induced morphological variations are unveiled. Further quantification of cell metabolism and stromal fibers reveals potential indicators for ESCC detection and grading. The specific identification of keratin pearls provides additional support for the early detection of ESCC. These findings demonstrate the viability of using MM-FLIM and the series of derived indicators for histopathological evaluation of ESCC. As there is an increasing interest in developing multiphoton endoscopes and multiphoton FLIM systems for clinical use, the proposed method would probably allow noninvasive, label-free, and multidimensional histological detection and grading of ESCC in the future.
Collapse
Affiliation(s)
- Feng Xiang
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Jia Yu
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Institute of Translational Medicine, Faculty of Health Sciences & Ministry of Education Frontiers Science Center for Precision Oncology, University of Macau, Taipa, Macau, China
| | - Danling Jiang
- Department of Gastroenterology, Peking University Shenzhen Hospital, Shen Zhen 518036, China
| | - Weiwang Hu
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Rongli Zhang
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Chenming Huang
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Ting Wu
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Yufeng Gao
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Aiping Zheng
- Department of Pathology, Peking University Shenzhen Hospital, Shen Zhen 518036, China
| | - Tzu-Ming Liu
- Institute of Translational Medicine, Faculty of Health Sciences & Ministry of Education Frontiers Science Center for Precision Oncology, University of Macau, Taipa, Macau, China
| | - Wei Zheng
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xi Li
- Department of Gastroenterology, Peking University Shenzhen Hospital, Shen Zhen 518036, China
| | - Hui Li
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- CAS Key Laboratory of Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| |
Collapse
|
3
|
Han W, Kong R, Wang N, Bao W, Mao X, Lu J. Confocal Laser Endomicroscopy for Detection of Early Upper Gastrointestinal Cancer. Cancers (Basel) 2023; 15:cancers15030776. [PMID: 36765734 PMCID: PMC9913498 DOI: 10.3390/cancers15030776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
Esophageal and gastric cancers are common diseases with high morbidity and mortality; thus, early detection and treatment are beneficial to improve prognosis. Confocal laser endomicroscopy (CLE) is a novel imaging technique that permits the histological analysis of tissues during endoscopy. CLE has been shown to uniquely affect the diagnosis of early upper gastrointestinal cancers. Relevant literature was searched using PubMed and Google Scholar databases. Despite inherent flaws, CLE can reduce tissue damage and improve diagnostic accuracy to a certain extent. CLE in combination with other imaging methods can help enhance the detection rate and avoid unnecessary biopsies in the management of esophageal or gastric cancer and precancerous lesions. CLE is of great significance in the diagnosis and surveillance of early cancers of the upper gastrointestinal tract. Further technical innovations and the standardisation of CLE will make it more responsive to the needs of routine clinical applications.
Collapse
Affiliation(s)
- Wei Han
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Rui Kong
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Nan Wang
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Wen Bao
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xinli Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang 317099, China
- Correspondence: (X.M.); (J.L.)
| | - Jie Lu
- Department of Gastroenterology, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200135, China
- Correspondence: (X.M.); (J.L.)
| |
Collapse
|
4
|
Sievert M, Mantsopoulos K, Mueller SK, Eckstein M, Rupp R, Aubreville M, Stelzle F, Oetter N, Maier A, Iro H, Goncalves M. Systematic interpretation of confocal laser endomicroscopy: larynx and pharynx confocal imaging score. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:26-33. [PMID: 35129541 PMCID: PMC9058938 DOI: 10.14639/0392-100x-n1643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/28/2021] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Development and validation of a confocal laser endomicroscopy (CLE) classification score for the larynx and pharynx. METHODS Thirteen patients (154 video sequences, 9240 images) with laryngeal or pharyngeal SCC were included in this prospective study between October 2020 and February 2021. Each CLE sequence was correlated with the gold standard of histopathological examination. Based on a dataset of 94 video sequences (5640 images), a scoring system was developed. In the remaining 60 sequences (3600 images), the score was validated by four CLE experts and four head and neck surgeons who were not familiar with CLE. RESULTS Tissue homogeneity, cell size, borders and clusters, capillary loops and the nucleus/cytoplasm ratio were defined as the scoring criteria. Using this score, the CLE experts obtained an accuracy, sensitivity, and specificity of 90.8%, 95.1%, and 86.4%, respectively, and the CLE non-experts of 86.2%, 86.4%, and 86.1%. Interobserver agreement Fleiss' kappa was 0.8 and 0.6, respectively. CONCLUSIONS CLE can be reliably evaluated based on defined and reproducible imaging features, which demonstrate a high diagnostic value. CLE can be easily integrated into the intraoperative setting and generate real-time, in-vivo microscopic images to demarcate malignant changes.
Collapse
Affiliation(s)
- Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Sarina K Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Robin Rupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | | | - Florian Stelzle
- Department of Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Nicolai Oetter
- Department of Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Andreas Maier
- Pattern Recognition Laboratory, Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Miguel Goncalves
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Rheinische Westfälische Technische Hochschule Aachen, University Hospital, Aachen, Germany
| |
Collapse
|
5
|
Paradigm Shift: Functional Dyspepsia-A "Leaky Gut" Disorder? Am J Gastroenterol 2021; 116:274-275. [PMID: 33298703 DOI: 10.14309/ajg.0000000000001077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
For up to 2 decades, pathophysiological research in functional dyspepsia focused on gastric sensorimotor dysfunction underlying symptom generation. Recent pathophysiological research has focused on low-grade inflammation in the duodenal mucosa. Emerging evidence confirms a loss of mucosal integrity in the duodenum in functional dyspepsia, and this is confirmed in a confocal laser endomicroscopy study demonstrating altered mucosal barrier function and pyroptosis. This technique may help to establish underlying mechanisms and evaluate novel therapeutic approaches to functional dyspepsia.
Collapse
|
6
|
Coste A, Oktay MH, Condeelis JS, Entenberg D. Intravital Imaging Techniques for Biomedical and Clinical Research. Cytometry A 2020; 97:448-457. [PMID: 31889408 PMCID: PMC7210060 DOI: 10.1002/cyto.a.23963] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/10/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
Intravital imaging, the direct visualization of cells and tissues within a living animal, is a technique that has been employed for the better part of a century. The advent of confocal and multiphoton microscopy has dramatically improved the power of intravital imaging, making it possible to obtain optical sections of tissues non-destructively. This review discusses the various techniques used for intravital imaging, describes how intravital imaging provides information about cellular and tissue dynamics not possible to be garnered by other techniques, and details several ways in which intravital imaging is making a direct impact on the clinical care of patients. © 2019 International Society for Advancement of Cytometry.
Collapse
Affiliation(s)
- Anouchka Coste
- Department of Surgery, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Department of Anatomy and Structural Biology, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Maja H. Oktay
- Department of Anatomy and Structural Biology, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Integrated Imaging Program, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Department of Pathology, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - John S. Condeelis
- Department of Surgery, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Department of Anatomy and Structural Biology, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Integrated Imaging Program, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - David Entenberg
- Department of Anatomy and Structural Biology, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Gruss-Lipper Biophotonics Center, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- Integrated Imaging Program, Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| |
Collapse
|
7
|
Haghighi M, Sethi A, Tavassoly I, Gonda TA, Poneros JM, McBride RB. Diagnosis of Pancreatic Cystic Lesions by Virtual Slicing: Comparison of Diagnostic Potential of Needle-Based Confocal Laser Endomicroscopy versus Endoscopic Ultrasound-Guided Fine-Needle Aspiration. J Pathol Inform 2019; 10:34. [PMID: 31799020 PMCID: PMC6883479 DOI: 10.4103/jpi.jpi_32_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/19/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pancreatic cystic lesions are often challenging entities for diagnosis and management. EUS-FNA diagnostic accuracy is limited by paucicellularity of cytology specimens and sampling errors. Needle-based confocal laser endomicroscopy (nCLE) provides real-time imaging of the microscopic structure of the cystic lesion and could result in a more accurate diagnosis. AIMS AND OBJECTIVES To determine the diagnostic utility of in vivo nCLE and EUS-FNA in the diagnosis and histologic characterization of pancreatic cystic lesions (PCL). MATERIALS AND METHODS All patients diagnosed with PCL who had undergone nCLE and FNA over a 10-year period within a major urban teaching hospital were included in this study. All gastroenterology reports of the nCLE images and corresponding pathologist findings from the EUS-FNA were collected and compared with, a final diagnosis prospectively collected from clinicopathological and imaging data. RESULTS A total of n=32 patients were included in this study, which consisted of n=13 serous cystadenoma (SCA), n=7 intraductal papillary mucinous neoplasms (IPMN), n=2 mucinous cystic neoplasms (MCN), n=3 well-differentiated neuroendocrine tumors, n=2 cysts, n=2 benign pancreatic lesions, n=1 adenocarcinoma, n=1 gastrointestinal stromal tumor (GIST) and n=1 lymphangioma. The overall diagnostic rate was higher in nCLE (87.5%) vs. EUS-FNA (71.9%) While the diagnostic accuracy of nCLE and EUS-FNA were comparable in characterization of benign vs. malignant lesions, the nCLE diagnosis demonstrated higher accuracy rate in identifying mucinous cystic neoplasms compared to EUS-FNA. CONCLUSION nCLE is a useful companion diagnostic tool for pancreatic cystic lesions and could assist the cytopathologist to better triage the sample for required ancillary testing and treatment planning. The combination of nCLE and EUS-FNA may be especially helpful in reducing the proportion of cases categorized as non-diagnostic.
Collapse
Affiliation(s)
- Mehrvash Haghighi
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center-New York-Presbyterian, New York City, New York, USA
| | - Iman Tavassoly
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Tamas A. Gonda
- Division of Digestive and Liver Diseases, Columbia University Medical Center-New York-Presbyterian, New York City, New York, USA
| | - John M. Poneros
- Division of Digestive and Liver Diseases, Columbia University Medical Center-New York-Presbyterian, New York City, New York, USA
| | - Russell B. McBride
- Department of Pathology, The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| |
Collapse
|
8
|
Bonhomme O, Duysinx B, Heinen V, Detrembleur N, Corhay JL, Louis R. First report of probe based confocal laser endomicroscopy during medical thoracoscopy. Respir Med 2019; 147:72-75. [DOI: 10.1016/j.rmed.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
|
9
|
Tabatabaei N, Kang D, Kim M, Wu T, Grant CN, Rosenberg M, Nishioka NS, Hesterberg PE, Garber J, Yuan Q, Katz AJ, Tearney GJ. Clinical Translation of Tethered Confocal Microscopy Capsule for Unsedated Diagnosis of Eosinophilic Esophagitis. Sci Rep 2018; 8:2631. [PMID: 29422678 PMCID: PMC5805683 DOI: 10.1038/s41598-018-20668-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/19/2018] [Indexed: 12/27/2022] Open
Abstract
Esophagogastroduodenoscopy (EGD) is a widely used procedure, posing significant financial burden on both healthcare systems and patients. Moreover, EGD is time consuming, sometimes difficult to tolerate, and suffers from an imperfect diagnostic yield as the limited number of collected biopsies does not represent the whole organ. In this paper, we report on technological and clinical feasibility of a swallowable tethered endomicroscopy capsule, which is administered without sedation, to image large regions of esophageal and gastric mucosa at the cellular level. To demonstrate imaging capabilities, we conducted a human pilot study (n = 17) on Eosinophilic Esophagitis (EoE) patients and healthy volunteers from which representative cases are presented and discussed. Results indicate that, compared to endoscopic biopsy, unsedated tethered capsule endomicroscopy obtains orders of magnitude more cellular information while successfully resolving characteristic tissue microscopic features such as stratified squamous epithelium, lamina propria papillae, intraepithelial eosinophils, and gastric cardia and body/fundic mucosa epithelia. Based on the major import of whole organ, cellular-level microscopy to obviate sampling error and the clear cost and convenience advantages of unsedated procedure, we believe that this tool has the potential to become a simpler and more effective device for diagnosing and monitoring the therapeutic response of EoE and other esophageal diseases.
Collapse
Affiliation(s)
- Nima Tabatabaei
- Department of Mechanical Engineering, Lassonde School of Engineering, York University, Toronto, ON M3J 1P3, Canada
| | - DongKyun Kang
- Wellman Center for Photomedicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Minkyu Kim
- Wellman Center for Photomedicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Tao Wu
- Wellman Center for Photomedicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Catriona N Grant
- Wellman Center for Photomedicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Mireille Rosenberg
- Wellman Center for Photomedicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Norman S Nishioka
- Department of Medicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Paul E Hesterberg
- Department of Medicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - John Garber
- Department of Medicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Qian Yuan
- Department of Medicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Aubrey J Katz
- Department of Medicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA
| | - Guillermo J Tearney
- Department of Medicine, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA. .,Department of Pathology, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA. .,Harvard-MIT Division of Health Science and Technology, Cambridge, MA, 02139, USA.
| |
Collapse
|
10
|
Li X, Li H, He X, Chen T, Xia X, Yang C, Zheng W. Spectrum- and time-resolved endogenous multiphoton signals reveal quantitative differentiation of premalignant and malignant gastric mucosa. BIOMEDICAL OPTICS EXPRESS 2018; 9:453-471. [PMID: 29552386 PMCID: PMC5854051 DOI: 10.1364/boe.9.000453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/25/2017] [Accepted: 12/30/2017] [Indexed: 05/09/2023]
Abstract
Early identification of premalignant and malignant gastric mucosa is crucial to decrease the incidence and mortality of stomach cancer. Spectrum- and time-resolved multiphoton microscopy are capable of providing not only structural but also biochemical information at the subcellular level. Based on this multidimensional imaging technique, we performed a systematic investigation on fresh human tissue specimens at the typical stages of gastric carcinogenesis, including normal, chronic gastritis with erosion, chronic gastritis with intestinal metaplasia, and intestinal-type adenocarcinoma. The results demonstrate that this technique is available to characterize the three-dimensional subcellular morphological and biochemical properties of gastric mucosa and further provide quantitative indicators of different gastric disorders, by using endogenous contrast. With advances in multiphoton endoscopy, it has the potential to allow noninvasive, label-free, real-time histological and functional diagnosis of premalignant and malignant lesions of stomach in the future.
Collapse
Affiliation(s)
- Xi Li
- Department of Gastroenterology, Peking University Shenzhen Hospital, Shen Zhen 518036, China
- Authors contributed equally to this work
| | - Hui Li
- Research Laboratory for Biomedical Optics and Molecular Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Authors contributed equally to this work
| | - Xingzhen He
- Department of Gastroenterology, Zhejiang Hospital, Hangzhou 310007, China
| | - Tingai Chen
- Research Laboratory for Biomedical Optics and Molecular Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xianyuan Xia
- Research Laboratory for Biomedical Optics and Molecular Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Chunxia Yang
- Department of Pathology, Jinchang First People's Hospital, Jinchang 737109, China
| | - Wei Zheng
- Research Laboratory for Biomedical Optics and Molecular Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| |
Collapse
|
11
|
Krishnamurthy S, Cortes A, Lopez M, Wallace M, Sabir S, Shaw K, Mills G. Ex Vivo Confocal Fluorescence Microscopy for Rapid Evaluation of Tissues in Surgical Pathology Practice. Arch Pathol Lab Med 2017; 142:396-401. [PMID: 29266968 DOI: 10.5858/arpa.2017-0164-oa] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Optical imaging techniques are currently available for imaging tissues without the need for any type of extensive tissue preparation. There are several applications for their potential use in surgical pathology practice. OBJECTIVE - To evaluate the feasibility of using a confocal fluorescence microscopy (CFM) platform for ex vivo examination of tissues obtained from surgical resections of breast, lung, kidney, and liver. DESIGN - Tissue fragments (0.5-1.0 cm) were immersed in 0.6 mM acridine orange for 6 seconds and imaged using a CFM platform at a 488-nm wavelength. The imaged tissues were subsequently fixed in formalin and processed routinely to generate hematoxylin-eosin-stained tissue sections. Mosaics of the grayscale CFM images were studied at different magnifications for recognition of the tissue and were compared with conventional histopathologic examination of hematoxylin-eosin tissue sections. RESULTS - We imaged 55 tissue fragments obtained from 16 breast (29%), 18 lung (33%), 14 kidney (25%), and 7 liver (13%) surgical excision specimens. Acridine orange labeled the nuclei, creating the contrast between nucleus and cytoplasm and thereby recapitulating the tissue architecture. We could obtain CFM images of good quality within 5 to 10 minutes that allowed recognition of the cytomorphologic details for categorization of the imaged tissue and were similar to histologic examination of hematoxylin-eosin tissue sections. CONCLUSIONS - The ease and speed of acquisition of CFM images together with the resolution and resemblance of the CFM images to hematoxylin-eosin sections suggest that the CFM platform has excellent potential for use in surgical pathology practice.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Gordon Mills
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Interventional Radiology (Ms Cortes and Drs Wallace and Sabir), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Ms Lopez and Drs Shaw and Mills), and the Department of Systems Biology (Dr Mills), The University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
12
|
Englhard AS, Palaras A, Volgger V, Stepp H, Mack B, Libl D, Gires O, Betz CS. Confocal laser endomicroscopy in head and neck malignancies using FITC-labelled EpCAM- and EGF-R-antibodies in cell lines and tumor biopsies. JOURNAL OF BIOPHOTONICS 2017; 10:1365-1376. [PMID: 28106950 DOI: 10.1002/jbio.201600238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/23/2016] [Accepted: 12/23/2016] [Indexed: 06/06/2023]
Abstract
Intraoperative detection of residual malignant cells at tumor margins following excision of primary tumors could help improving surgery and thus patients' outcome. The feasibility of the tumor antigens epidermal growth factor receptor (EGF-R) and epithelial cell adhesion molecule (EpCAM) for antibody-dependent confocal laser scanning endomicroscopy (CLE)-mediated visualization of malignant cells was addressed. Both tumor antigens are highly and frequently expressed in the majority of carcinomas, including head and neck squamous cell carcinomas (HNSCC), and represent prognostic and therapeutic tumor target molecules. FITC-conjugated EGF-R- and EpCAM-specific antibodies served as molecular tools for the detection of antigen-positive cells using the CLE technology. Specificity of both antibodies and their ability to discriminate tumor from non-tumor cells were assessed in vitro with human fibroblasts and PCI-1 HNSCC cell lines, and ex vivo on primary HNSCC samples (n = 11) and healthy mucosa (n = 5). Antigen specificity of the used EpCAM-specific antibody was superior to that of the EGF-R-specific antibody both in vitro and ex vivo (100% vs. 31.25%), and allowed visualization of cellular structures in CLE measurements. These results hold promise for possible future applications in humans.
Collapse
Affiliation(s)
- Anna S Englhard
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Palaras
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Feodor-Lynen-Str. 19, 81377, Munich, Germany
| | - Veronika Volgger
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Herbert Stepp
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Feodor-Lynen-Str. 19, 81377, Munich, Germany
- Department of Urology, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Brigitte Mack
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Darko Libl
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Olivier Gires
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
- Clinical Cooperation Group "Personalized Radiotherapy of Head and Neck Tumors", Helmholtz Zentrum, München, Germany
| | - Christian S Betz
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
13
|
Novikova T. Optical techniques for cervical neoplasia detection. BEILSTEIN JOURNAL OF NANOTECHNOLOGY 2017; 8:1844-1862. [PMID: 29046833 PMCID: PMC5629403 DOI: 10.3762/bjnano.8.186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/09/2017] [Indexed: 05/04/2023]
Abstract
This paper provides an overview of the current research in the field of optical techniques for cervical neoplasia detection and covers a wide range of the existing and emerging technologies. Using colposcopy, a visual inspection of the uterine cervix with a colposcope (a binocular microscope with 3- to 15-fold magnification), has proven to be an efficient approach for the detection of invasive cancer. Nevertheless, the development of a reliable and cost-effective technique for the identification of precancerous lesions, confined to the epithelium (cervical intraepithelial neoplasia) still remains a challenging problem. It is known that even at early stages the neoplastic transformations of cervical tissue induce complex changes and modify both structural and biochemical properties of tissues. The different methods, including spectroscopic (diffuse reflectance spectroscopy, induced fluorescence and autofluorescence spectroscopy, Raman spectroscopy) and imaging techniques (confocal microscopy, optical coherence tomography, Mueller matrix imaging polarimetry, photoacoustic imaging), probe different tissue properties that may serve as optical biomarkers for diagnosis. Both the advantages and drawbacks of these techniques for the diagnosis of cervical precancerous lesions are discussed and compared.
Collapse
Affiliation(s)
- Tatiana Novikova
- LPICM, CNRS, Ecole polytechnique, University Paris Saclay, Palaiseau, France
| |
Collapse
|
14
|
Oetter N, Knipfer C, Rohde M, von Wilmowsky C, Maier A, Brunner K, Adler W, Neukam FW, Neumann H, Stelzle F. Development and validation of a classification and scoring system for the diagnosis of oral squamous cell carcinomas through confocal laser endomicroscopy. J Transl Med 2016; 14:159. [PMID: 27255924 PMCID: PMC4891821 DOI: 10.1186/s12967-016-0919-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/20/2016] [Indexed: 12/11/2022] Open
Abstract
Background Confocal laser endomicroscopy (CLE) is an optical biopsy method allowing in vivo microscopic imaging at 1000-fold magnification. It was the aim to evaluate CLE in the human oral cavity for the differentiation of physiological/carcinomatous mucosa and to establish and validate, for the first time, a scoring system to facilitate CLE assessment. Methods The study consisted of 4 phases: (1) CLE-imaging (in vivo) was performed after the intravenous injection of fluorescein in patients with histologically confirmed carcinomatous oral mucosa; (2) CLE-experts (n = 3) verified the applicability of CLE in the oral cavity for the differentiation between physiological and cancerous tissue compared to the gold standard of histopathological assessment; (3) based on specific patterns of tissue changes, CLE-experts (n = 3) developed a classification and scoring system (DOC-Score) to simplify the diagnosis of oral squamous cell carcinomas; (4) validation of the newly developed DOC-Score by non-CLE-experts (n = 3); final statistical evaluation of their classification performance (comparison to the results of CLE-experts and the histopathological analyses). Results Experts acquired and edited 45 sequences (260 s) of physiological and 50 sequences (518 s) of carcinomatous mucosa (total: 95 sequences/778 s). All sequences were evaluated independently by experts and non-experts (based on the newly proposed classification system). Sensitivity (0.953) and specificity (0.889) of the diagnoses by experts as well as sensitivity (0.973) and specificity (0.881) of the non-expert ratings correlated well with the results of the present gold standard of tissue histopathology. Experts had a positive predictive value (PPV) of 0.905 and a negative predictive value (NPV) of 0.945. Non-experts reached a PPV of 0.901 and a NPV of 0.967 with the help of the DOC-Score. Inter-rater reliability (Fleiss` kappa) was 0.73 for experts and 0.814 for non-experts. The intra-rater reliability (Cronbach’s alpha) of the experts was 0.989 and 0.884 for non-experts. Conclusions CLE is a suitable and valid method for experts to diagnose oral cancer. Using the DOC-Score system, an accurate chair-side diagnosis of oral cancer is feasible with comparable results to the gold standard of histopathology—even in daily clinical practice for non-experienced raters.
Collapse
Affiliation(s)
- Nicolai Oetter
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany.
| | - Christian Knipfer
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany.,SAOT-Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Paul Gordan Strasse 6, 91052, Erlangen, Germany
| | - Maximilian Rohde
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany.,SAOT-Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Paul Gordan Strasse 6, 91052, Erlangen, Germany
| | - Cornelius von Wilmowsky
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Andreas Maier
- Department of Computer Science 5, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Martensstraße 3, 91058, Erlangen, Germany.,SAOT-Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Paul Gordan Strasse 6, 91052, Erlangen, Germany
| | - Kathrin Brunner
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Krankenhausstr. 8-10, 91054, Erlangen, Germany
| | - Werner Adler
- Department of Medical Information Technology, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Waldstraße 6, 91054, Erlangen, Germany
| | - Friedrich-Wilhelm Neukam
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany.,SAOT-Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Paul Gordan Strasse 6, 91052, Erlangen, Germany
| | - Helmut Neumann
- Department of Medicine I, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,SAOT-Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Paul Gordan Strasse 6, 91052, Erlangen, Germany
| | - Florian Stelzle
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany.,SAOT-Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Paul Gordan Strasse 6, 91052, Erlangen, Germany
| |
Collapse
|
15
|
Abstract
First developed in 1957, confocal microscopy is a powerful imaging tool that can be used to obtain near real-time reflected light images of untreated human tissue with nearly histologic resolution. Besides its research applications, in the last decades, confocal microscopy technology has been proposed as a useful device to improve clinical diagnosis, especially in ophthalmology, dermatology, and endomicroscopy settings, thanks to advances in instrument development. Compared with the wider use of the in vivo tissue assessment, ex vivo applications of confocal microscopy are not fully explored. A comprehensive review of the current literature was performed here, focusing on the reliable applications of ex vivo confocal microscopy in surgical pathology and on some potential evolutions of this new technique from pathologists' viewpoint.
Collapse
|
16
|
Kamen A, Sun S, Wan S, Kluckner S, Chen T, Gigler AM, Simon E, Fleischer M, Javed M, Daali S, Igressa A, Charalampaki P. Automatic Tissue Differentiation Based on Confocal Endomicroscopic Images for Intraoperative Guidance in Neurosurgery. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6183218. [PMID: 27127791 PMCID: PMC4835625 DOI: 10.1155/2016/6183218] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/15/2016] [Accepted: 01/18/2016] [Indexed: 11/18/2022]
Abstract
Diagnosis of tumor and definition of tumor borders intraoperatively using fast histopathology is often not sufficiently informative primarily due to tissue architecture alteration during sample preparation step. Confocal laser microscopy (CLE) provides microscopic information of tissue in real-time on cellular and subcellular levels, where tissue characterization is possible. One major challenge is to categorize these images reliably during the surgery as quickly as possible. To address this, we propose an automated tissue differentiation algorithm based on the machine learning concept. During a training phase, a large number of image frames with known tissue types are analyzed and the most discriminant image-based signatures for various tissue types are identified. During the procedure, the algorithm uses the learnt image features to assign a proper tissue type to the acquired image frame. We have verified this method on the example of two types of brain tumors: glioblastoma and meningioma. The algorithm was trained using 117 image sequences containing over 27 thousand images captured from more than 20 patients. We achieved an average cross validation accuracy of better than 83%. We believe this algorithm could be a useful component to an intraoperative pathology system for guiding the resection procedure based on cellular level information.
Collapse
Affiliation(s)
- Ali Kamen
- Siemens Healthcare, Technology Center, Princeton, NJ 08540, USA
| | - Shanhui Sun
- Siemens Healthcare, Technology Center, Princeton, NJ 08540, USA
| | - Shaohua Wan
- Siemens Healthcare, Technology Center, Princeton, NJ 08540, USA
| | - Stefan Kluckner
- Siemens Healthcare, Technology Center, Princeton, NJ 08540, USA
| | - Terrence Chen
- Siemens Healthcare, Technology Center, Princeton, NJ 08540, USA
| | | | | | | | - Mehreen Javed
- Department of Neurosurgery, Hospital Merheim, Cologne Medical Center, 51109 Cologne, Germany
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, 40255 Düsseldorf, Germany
| | - Samira Daali
- Department of Neurosurgery, Hospital Merheim, Cologne Medical Center, 51109 Cologne, Germany
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, 40255 Düsseldorf, Germany
| | - Alhadi Igressa
- Department of Neurosurgery, Hospital Merheim, Cologne Medical Center, 51109 Cologne, Germany
| | - Patra Charalampaki
- Department of Neurosurgery, Hospital Merheim, Cologne Medical Center, 51109 Cologne, Germany
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, 40255 Düsseldorf, Germany
| |
Collapse
|
17
|
Bishitz Y, Ozana N, Schwarz A, Beiderman Y, Garcia J, Zalevsky Z. Optical configuration of pigmented lesion detection by frequency analysis of skin speckle patterns. BIOMEDICAL OPTICS EXPRESS 2016; 7:1003-14. [PMID: 27231603 PMCID: PMC4866444 DOI: 10.1364/boe.7.001003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/14/2016] [Accepted: 02/04/2016] [Indexed: 05/03/2023]
Abstract
In this paper we present a novel approach of realizing a safe, simple, and inexpensive sensor applicable to pigmented lesions detection. The approach is based on temporal tracking of back-reflected secondary speckle patterns generated while illuminating the affected area with a laser and applying periodic pressure to the surface via a controlled vibration source. When applied to pigmented lesions, the technique is superior to visual examination in avoiding many false positives and resultant unnecessary biopsies. Applying a series of different vibration frequencies at the examined tissue and analyzing the 2-D time varying speckle patterns in response to the applied periodic pressure creates a unique signature for each and different pigmented lesion. Analyzing these signatures is the first step toward detection of malignant melanoma. In this paper we present preliminary experiments that show the validity of the developed sensor for the classification of pigmented lesions.
Collapse
Affiliation(s)
- Yael Bishitz
- Faculty of Engineering and the Nano Technology Center, Bar-Ilan University, Ramat-Gan 52900, Israel
- These authors contributed equally to the paper
| | - Nisan Ozana
- Faculty of Engineering and the Nano Technology Center, Bar-Ilan University, Ramat-Gan 52900, Israel
- These authors contributed equally to the paper
| | - Ariel Schwarz
- Faculty of Engineering and the Nano Technology Center, Bar-Ilan University, Ramat-Gan 52900, Israel
| | - Yevgeny Beiderman
- Faculty of Engineering and the Nano Technology Center, Bar-Ilan University, Ramat-Gan 52900, Israel
| | - Javier Garcia
- Departamento de O ´ptica, Universitat de46100 Burjassot, Spain
| | - Zeev Zalevsky
- Faculty of Engineering and the Nano Technology Center, Bar-Ilan University, Ramat-Gan 52900, Israel
| |
Collapse
|
18
|
Volgger V, Girschick S, Ihrler S, Englhard AS, Stepp H, Betz CS. Evaluation of confocal laser endomicroscopy as an aid to differentiate primary flat lesions of the larynx: A prospective clinical study. Head Neck 2015; 38 Suppl 1:E1695-704. [DOI: 10.1002/hed.24303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 08/09/2015] [Accepted: 09/19/2015] [Indexed: 01/26/2023] Open
Affiliation(s)
- Veronika Volgger
- Department of Otorhinolaryngology; Head and Neck Surgery; Klinikum der Universität München; Munich Germany
| | - Susanne Girschick
- Department of Otorhinolaryngology; Head and Neck Surgery; Klinikum der Universität München; Munich Germany
- Laser-Forschungslabor; LIFE Center; Klinikum der Universität München; Munich Germany
| | - Stephan Ihrler
- Labor für Dermatohistologie und Oralpathologie; Munich Germany
| | - Anna Sophie Englhard
- Department of Otorhinolaryngology; Head and Neck Surgery; Klinikum der Universität München; Munich Germany
| | - Herbert Stepp
- Laser-Forschungslabor; LIFE Center; Klinikum der Universität München; Munich Germany
| | - Christian Stephan Betz
- Department of Otorhinolaryngology; Head and Neck Surgery; Klinikum der Universität München; Munich Germany
| |
Collapse
|
19
|
Towards an Efficient Computational Framework for Guiding Surgical Resection through Intra-operative Endo-microscopic Pathology. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/978-3-319-24553-9_52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
20
|
Dittberner A, Rodner E, Ortmann W, Stadler J, Schmidt C, Petersen I, Stallmach A, Denzler J, Guntinas-Lichius O. Automated analysis of confocal laser endomicroscopy images to detect head and neck cancer. Head Neck 2015; 38 Suppl 1:E1419-26. [PMID: 26560348 DOI: 10.1002/hed.24253] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of this study was to develop an automated image analysis algorithm to discriminate between head and neck cancer and nonneoplastic epithelium in confocal laser endomicroscopy (CLE) images. METHODS CLE was applied to image head and neck cancer epithelium in vivo. Histopathologic diagnosis from biopsies was used to classify the CLE images offline as cancer or noncancer tissue. The classified images were used to train automated software based on distance map histograms. The performance of the final algorithm was confirmed by "leave 2 patients out" cross-validation and area under the curve (AUC)/receiver operating characteristic (ROC) analysis. RESULTS Ninety-two CLE videos and 92 biopsies were analyzed from 12 patients. One hundred two frames of classified neoplastic tissue and 52 frames of nonneoplastic tissue were used for cross-validation of the developed algorithm. AUC varied from 0.52 to 0.92. CONCLUSION The proposed software allows an objective classification of CLE images of head and neck cancer and adjacent nonneoplastic epithelium. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1419-E1426, 2016.
Collapse
Affiliation(s)
- Andreas Dittberner
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Erik Rodner
- Department of Computer Science, Friedrich Schiller University, Jena, Germany
| | - Wolfgang Ortmann
- Department of Computer Science, Friedrich Schiller University, Jena, Germany
| | - Joachim Stadler
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Department of Otorhinolaryngology, Heinrich-Braun-Klinikum, Zwickau, Germany
| | - Carsten Schmidt
- Division of Gastroenterology, Hepatology and Infectious Diseases, Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Iver Petersen
- Institute of Pathology, Jena University Hospital, Jena, Germany
| | - Andreas Stallmach
- Division of Gastroenterology, Hepatology and Infectious Diseases, Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Joachim Denzler
- Department of Computer Science, Friedrich Schiller University, Jena, Germany
| | | |
Collapse
|
21
|
Robles LY, Singh S, Fisichella PM. Emerging enhanced imaging technologies of the esophagus: spectroscopy, confocal laser endomicroscopy, and optical coherence tomography. J Surg Res 2015; 195:502-14. [PMID: 25819772 DOI: 10.1016/j.jss.2015.02.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/04/2015] [Accepted: 02/18/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite advances in diagnoses and therapy, esophageal adenocarcinoma remains a highly lethal neoplasm. Hence, a great interest has been placed in detecting early lesions and in the detection of Barrett esophagus (BE). Advanced imaging technologies of the esophagus have then been developed with the aim of improving biopsy sensitivity and detection of preplastic and neoplastic cells. The purpose of this article was to review emerging imaging technologies for esophageal pathology, spectroscopy, confocal laser endomicroscopy (CLE), and optical coherence tomography (OCT). METHODS We conducted a PubMed search using the search string "esophagus or esophageal or oesophageal or oesophagus" and "Barrett or esophageal neoplasm" and "spectroscopy or optical spectroscopy" and "confocal laser endomicroscopy" and "confocal microscopy" and "optical coherence tomography." The first and senior author separately reviewed all articles. Our search identified: 19 in vivo studies with spectroscopy that accounted for 1021 patients and 4 ex vivo studies; 14 clinical CLE in vivo studies that accounted for 941 patients and 1 ex vivo study with 13 patients; and 17 clinical OCT in vivo studies that accounted for 773 patients and 2 ex vivo studies. RESULTS Human studies using spectroscopy had a very high sensitivity and specificity for the detection of BE. CLE showed a high interobserver agreement in diagnosing esophageal pathology and an accuracy of predicting neoplasia. We also found several clinical studies that reported excellent diagnostic sensitivity and specificity for the detection of BE using OCT. CONCLUSIONS Advanced imaging technology for the detection of esophageal lesions is a promising field that aims to improve the detection of early esophageal lesions. Although advancing imaging techniques improve diagnostic sensitivities and specificities, their integration into diagnostic protocols has yet to be perfected.
Collapse
Affiliation(s)
| | - Satish Singh
- Division of Gastroenterology, Boston VA Healthcare System, Boston University, Boston, Massachusetts
| | - Piero Marco Fisichella
- Department of Surgery, Boston VA Healthcare System, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
22
|
Walavalkar V, Patwardhan RV, Owens CL, Lithgow M, Wang X, Akalin A, Nompleggi DJ, Zivny J, Wassef W, Marshall C, Levey J, Walter O, Fischer AH. Utility of liquid-based cytologic examination of distal esophageal brushings in the management of Barrett esophagus: a prospective study of 45 cases. J Am Soc Cytopathol 2015; 4:113-121. [PMID: 31051691 DOI: 10.1016/j.jasc.2014.09.208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The goal of Barrett esophagus surveillance is to identify high-grade dysplasia (HGD) for eradication. Surveillance programs currently rely on limited histologic sampling; however, the role of cytology in this setting is not well studied. MATERIALS AND METHODS From December 1, 2011 to March 30, 2014, 45 patients underwent 4 circumferential brushings of the distal tubular esophagus followed by standard 4-quadrant biopsies. One ThinPrep slide and 1 Cellient cellblock (Hologic, Boxborough, Mass) were prepared. Six cytopathologists evaluated each for adequacy, intestinal metaplasia (IM) and dysplasia. Findings were classified using the traditional 5-tier system used for biopsies. A prospectively modified 3-tier cytologic classification was also tested: negative for HGD, indeterminate for HGD, and HGD. Sensitivity, specificity, and kappa values (interobserver agreement) for cytology were calculated. RESULTS Ten of 45 patients had nondiagnostic cytologies; none of whom had dysplasia on biopsy. Cytology had good sensitivity (82%) and specificity (88%) for identifying IM compared with biopsy with moderate interobserver agreement (pairwise average of Fleiss and Krippendorf kappa value = 0.589, 79% agreement). One case had IM on cytology not detected on histology. Six of 45 patients had dysplasia on biopsy including 1 intramucosal adenocarcinoma, 1 indeterminate for dysplasia, 2 high-grade dysplasias, and 2 low-grade dysplasias. A non-negative adequate cytology sample had a sensitivity of 100% and a specificity of 88% and 94% for the 5-tier and the 3-tier classification, respectively. CONCLUSIONS Cytology appears to have good sensitivity and specificity for diagnosis of HGD, and cytology may be poised to synergize with advances in other techniques for management of patients with Barrett esophagus. Improvements in brushing devices may help to decrease the nondiagnostic rate.
Collapse
Affiliation(s)
- Vighnesh Walavalkar
- Department of Cytopathology, University of Massachusetts Medical School, Three Biotech, One Innovation Drive, Worcester, Massachusetts
| | - Rashmi V Patwardhan
- Department of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Christopher L Owens
- Department of Cytopathology, University of Massachusetts Medical School, Three Biotech, One Innovation Drive, Worcester, Massachusetts
| | - Marie Lithgow
- Department of Cytopathology, University of Massachusetts Medical School, Three Biotech, One Innovation Drive, Worcester, Massachusetts
| | - Xiaofei Wang
- Department of Cytopathology, University of Massachusetts Medical School, Three Biotech, One Innovation Drive, Worcester, Massachusetts
| | - Ali Akalin
- Department of Cytopathology, University of Massachusetts Medical School, Three Biotech, One Innovation Drive, Worcester, Massachusetts
| | - Dominic J Nompleggi
- Department of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jaroslav Zivny
- Department of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Wahid Wassef
- Department of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Christopher Marshall
- Department of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - John Levey
- Department of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Otto Walter
- Department of Cytopathology, University of Massachusetts Medical School, Three Biotech, One Innovation Drive, Worcester, Massachusetts
| | - Andrew H Fischer
- Department of Cytopathology, University of Massachusetts Medical School, Three Biotech, One Innovation Drive, Worcester, Massachusetts.
| |
Collapse
|
23
|
Liu L, Yin J, Liu C, Guan G, Shi D, Wang X, Xu B, Tian Z, Zhao J, Nie Y, Wang B, Liang S, Wu K, Ding J. In vivo molecular imaging of gastric cancer in human-murine xenograft models with confocal laser endomicroscopy using a tumor vascular homing peptide. Cancer Lett 2014; 356:891-8. [PMID: 25449775 DOI: 10.1016/j.canlet.2014.10.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/29/2014] [Accepted: 10/30/2014] [Indexed: 01/08/2023]
Abstract
The early detection of premalignant lesions and cancers are very important for improving the survival of patients with gastric malignancies. Confocal laser endomicroscopy (CLE) is a novel imaging tool for achieving real-time microscopy during the ongoing endoscopy at subcellular resolution. In the present study, to evaluate the feasibility of real-time molecular imaging of GEBP11 by CLE in gastric cancer, CLE was performed on two types of tumor-bearing mice models, as well as surgical specimens of patients with gastric cancer, after the application of GEBP11. A whole-body fluorescent imaging device was first used to screen for the strongest specific fluorescent signal in xenograft models. Next, the tumor sites, as well as human tissues, were scanned with CLE. After this, targeted specimens were obtained for fluorescence microscopy and histology. We confirmed that GEBP11 could specifically bind to co-HUVECs by means of CLE in cell experiments. Thereafter, a specific signal was observed in both subcutaneous and orthotopic xenograft models in vivo after the injection of FITC-GEBP11 via tail vein, whereas the group injected with FITC-URP showed no fluorescent signals. In human tissues, a specific signal of GEBP11 was observed in 26/28 neoplastic specimens and in 8/28 samples of non-neoplastic specimens from the patients (p < 0.01). The findings from ex vivo immunofluorescence microscopy of cryostat sections correlated well with that obtained by CLE. These findings indicate that the peptide, GEBP11, might be a potential candidate for the molecular imaging of gastric cancer.
Collapse
Affiliation(s)
- Lijuan Liu
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jipeng Yin
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Changhao Liu
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guofeng Guan
- Orthopaedic Oncology Institute, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Doufei Shi
- Department of Geriatrics, Affiliated Hospital of Binzhou Medical University, Binzhou, China
| | - Xiaojuan Wang
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Bing Xu
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zuhong Tian
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing Zhao
- Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yongzhan Nie
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Biaoluo Wang
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shuhui Liang
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Kaichun Wu
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Jie Ding
- State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| |
Collapse
|
24
|
Advances in imaging probes and optical microendoscopic imaging techniques for early in vivo cancer assessment. Adv Drug Deliv Rev 2014; 74:53-74. [PMID: 24120351 DOI: 10.1016/j.addr.2013.09.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 09/18/2013] [Accepted: 09/27/2013] [Indexed: 12/12/2022]
Abstract
A new chapter in the history of medical diagnosis happened when the first X-ray technology was invented in the late 1800s. Since then, many non-invasive and minimally invasive imaging techniques have been invented for clinical diagnosis to research in cellular biology, drug discovery, and disease monitoring. These imaging modalities have leveraged the benefits of significant advances in computer, electronics, and information technology and, more recently, targeted molecular imaging. The development of targeted contrast agents such as fluorescent and nanoparticle probes coupled with optical imaging techniques has made it possible to selectively view specific biological events and processes in both in vivo and ex vivo systems with great sensitivity and selectivity. Thus, the combination of targeted molecular imaging probes and optical imaging techniques have become a mainstay in modern medicinal and biological research. Many promising results have demonstrated great potentials to translate to clinical applications. In this review, we describe a discussion of employing imaging probes and optical microendoscopic imaging techniques for cancer diagnosis.
Collapse
|
25
|
Shulimzon TR. Reply: is it actually a pCLE image of a sarcoid granuloma? Am J Respir Crit Care Med 2014; 189:236. [PMID: 24428660 DOI: 10.1164/rccm.201307-1373le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
26
|
Gong S, Ge ZZ, Xue HB. In vivo diagnosis of gastric signet-ring cell carcinoma by confocal laser endomicroscopy. J Dig Dis 2014; 15:46-9. [PMID: 23937516 DOI: 10.1111/1751-2980.12093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shuai Gong
- Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Institute of Digestive Disease, Shanghai, China
| | | | | |
Collapse
|
27
|
Tabatabaei N, Kang D, Wu T, Kim M, Carruth RW, Leung J, Sauk JS, Shreffler W, Yuan Q, Katz A, Nishioka NS, Tearney GJ. Tethered confocal endomicroscopy capsule for diagnosis and monitoring of eosinophilic esophagitis. BIOMEDICAL OPTICS EXPRESS 2013; 5:197-207. [PMID: 24466487 PMCID: PMC3891332 DOI: 10.1364/boe.5.000197] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/13/2013] [Accepted: 11/18/2013] [Indexed: 05/04/2023]
Abstract
Eosinophilic esophagitis (EoE) is an allergic condition that is characterized by eosinophils infiltrating the esophageal wall. The treatment of the disease may require multiple follow up sedated endoscopies and biopsies to confirm elimination of eosinophils. These procedures are expensive, time consuming, and may be difficult for patients to tolerate. Here we report on the development of a confocal microscopy capsule for diagnosis and monitoring of EoE. The swallowable capsule implements a high-speed fiber-based reflectance confocal microscopy technique termed Spectrally Encoded Confocal Microscopy (SECM). SECM scans the sample in one dimension without moving parts by using wavelength swept source illumination and a diffraction grating at the back plane of the objective lens. As the wavelength of the source is tuned, the SECM optics within the 7 x 30 mm capsule are rotated using a driveshaft enclosed in a 0.8 mm flexible tether. A single rotation of the optics covered a field of view of 22 mm x 223 µm. The lateral and axial resolutions of the device were measured to be 2.1 and 14 µm, respectively. Images of Acetic Acid stained swine esophagus obtained with the capsule ex vivo and in vivo clearly showed squamous epithelial nuclei, which are smaller and less reflective than eosinophils. Imaging of esophageal biopsies from EoE patients ex vivo demonstrated the capability of this technology to visualize individual eosinophils. Based on the results of this study, we believe that this capsule will be a simpler and more effective device for diagnosing EoE and monitoring the therapeutic response of this disease.
Collapse
Affiliation(s)
- Nima Tabatabaei
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - DongKyun Kang
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Tao Wu
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Minkyu Kim
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- School of Engineering, The University of Tokyo, Yayoi 2-11-16 Bunkyo, Tokyo 113-8656, Japan
| | - Robert W. Carruth
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - John Leung
- Food Allergy Center and Pediatric Allergy & Immunology, Harvard Medical School/Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jenny S Sauk
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Wayne Shreffler
- Food Allergy Center and Pediatric Allergy & Immunology, Harvard Medical School/Massachusetts General Hospital, Boston, MA 02114, USA
| | - Qian Yuan
- Department of Pediatrics, Harvard Medical School/Massachusetts General Hospital, Boston, MA 02114, USA
| | - Aubrey Katz
- Department of Pediatrics, Harvard Medical School/Massachusetts General Hospital, Boston, MA 02114, USA
| | - Norman S Nishioka
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Guillermo J. Tearney
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
- Department of Pathology, Harvard Medical School/Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| |
Collapse
|
28
|
Abstract
Context.—Cytology relies heavily on morphology to make diagnoses, and morphologic criteria have not changed much in recent years. The field is being shaped predominantly by new techniques for imaging and for acquiring and processing samples, advances in molecular diagnosis and therapeutics, and regulatory issues.
Objective.—To review the importance of classical morphology in the future of cytopathology, to identify areas in which cytology is expanding or contracting in its scope, and to identify factors that are shaping the field.
Data Sources.—Literature review.
Conclusions.—Five stories paint a picture in which classical cytomorphology will continue to have essential importance, both for diagnosis and for improving our understanding of cancer biology. New endoscopy and imaging techniques are replacing surgical biopsies with cytology samples. New molecularly targeted therapies offer a chance for cytology to play a major role, but they pose new challenges. New molecular tests have the potential to synergize with, but not replace, morphologic interpretation of thyroid fine-needle aspirations. Ultrasound-guided fine-needle aspiration performed by cytopathologists is opening a new field of “interventional cytopathology” with unique value. For the productive evolution of the field, it will be important for cytopathologists to play an active role in clinical trials that document the ability of cytology to achieve cost-effective health care outcomes.
Collapse
Affiliation(s)
- Andrew H. Fischer
- From the Department of Pathology, University of Massachusetts Medical Center, Worcester, Massachusetts (Dr Fischer); the Department of Cytopathology, DCL Medical Laboratories, Inc, Indianapolis, Indiana (Dr Benedict); and the Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas (Dr Amrikachi)
| | - Cynthia C. Benedict
- From the Department of Pathology, University of Massachusetts Medical Center, Worcester, Massachusetts (Dr Fischer); the Department of Cytopathology, DCL Medical Laboratories, Inc, Indianapolis, Indiana (Dr Benedict); and the Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas (Dr Amrikachi)
| | - Mojgan Amrikachi
- From the Department of Pathology, University of Massachusetts Medical Center, Worcester, Massachusetts (Dr Fischer); the Department of Cytopathology, DCL Medical Laboratories, Inc, Indianapolis, Indiana (Dr Benedict); and the Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas (Dr Amrikachi)
| |
Collapse
|
29
|
|
30
|
Makino T, Jain M, Montrose DC, Aggarwal A, Sterling J, Bosworth BP, Milsom JW, Robinson BD, Shevchuk MM, Kawaguchi K, Zhang N, Brown CM, Rivera DR, Williams WO, Xu C, Dannenberg AJ, Mukherjee S. Multiphoton tomographic imaging: a potential optical biopsy tool for detecting gastrointestinal inflammation and neoplasia. Cancer Prev Res (Phila) 2012; 5:1280-90. [PMID: 22961775 DOI: 10.1158/1940-6207.capr-12-0132] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endoscopy is widely used to detect and remove premalignant lesions with the goal of preventing gastrointestinal (GI) cancers. Because current endoscopes do not provide cellular resolution, all suspicious lesions are biopsied and subjected to histologic evaluation. Technologies that facilitate directed biopsies should decrease both procedure-related morbidity and cost. Here we explore the use of multiphoton microscopy (MPM), an optical biopsy tool that relies on intrinsic tissue emissions, to evaluate pathology in both experimental and human GI specimens, using hematoxylin and eosin (H&E)-stained sections from these tissues for comparison. After evaluating the entire normal mouse GI tract, MPM was used to investigate disease progression in mouse models of colitis and colorectal carcinogenesis. MPM provided sufficient histologic detail to identify all relevant substructures in ex vivo normal GI tissue, visualize both acute and resolving stages of colitis, and show the progression of colorectal carcinogenesis. Next, ex vivo specimens from human subjects with celiac sprue, inflammatory bowel disease, and colorectal neoplasia were imaged by MPM. Finally, colonic mucosa in live anesthetized rats was imaged in vivo using a flexible endoscope prototype. In both animal models and human specimens, MPM images showed a striking similarity to the results of H&E staining, as shown by the 100% concordance achieved by the study pathologists' diagnoses. In summary, MPM is a promising technique that accurately visualizes histology in fresh, unstained tissues. Our findings support the continued development of MPM as a technology to enhance the early detection of GI pathologies including premalignant lesions.
Collapse
Affiliation(s)
- Tomoki Makino
- Department of Medicine, Medical College of Cornell University, New York, NY 10065, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Carignan CS, Yagi Y. Optical endomicroscopy and the road to real-time, in vivo pathology: present and future. Diagn Pathol 2012; 7:98. [PMID: 22889003 PMCID: PMC3502368 DOI: 10.1186/1746-1596-7-98] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 07/19/2012] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Epithelial cancers account for substantial mortality and are an important public health concern. With the need for earlier detection and treatment of these malignancies, the ability to accurately detect precancerous lesions has an increasingly important role in controlling cancer incidence and mortality. New optical technologies are capable of identifying early pathology in tissues or organs in which cancer is known to develop through stages of dysplasia, including the esophagus, colon, pancreas, liver, bladder, and cervix. These diagnostic imaging advances, together as a field known as optical endomicroscopy, are based on confocal microscopy, spectroscopy-based imaging, and optical coherence tomography (OCT), and function as "optical biopsies," enabling tissue pathology to be imaged in situ and in real time without the need to excise and process specimens as in conventional biopsy and histopathology. Optical biopsy techniques can acquire high-resolution, cross-sectional images of tissue structure on the micron scale through the use of endoscopes, catheters, laparoscopes, and needles. Since the inception of these technologies, dramatic technological advances in accuracy, speed, and functionality have been realized. The current paradigm of optical biopsy, or single-area, point-based images, is slowly shifting to more comprehensive microscopy of larger tracts of mucosa. With the development of Fourier-domain OCT, also known as optical frequency domain imaging or, more recently, volumetric laser endomicroscopy, comprehensive surveillance of the entire distal esophagus is now achievable at speeds that were not possible with conventional OCT technologies. Optical diagnostic technologies are emerging as clinically useful tools with the potential to set a new standard for real-time diagnosis. New imaging techniques enable visualization of high-resolution, cross-sectional images and offer the opportunity to guide biopsy, allowing maximal diagnostic yields and appropriate staging without the limitations and risks inherent with current random biopsy protocols. However, the ability of these techniques to achieve widespread adoption in clinical practice depends on future research designed to improve accuracy and allow real-time data transmission and storage, thereby linking pathology to the treating physician. These imaging advances are expected to eventually offer a see-and-treat paradigm, leading to improved patient care and potential cost reduction. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5372548637202968.
Collapse
|
32
|
Chen Y, Liang CP, Liu Y, Fischer AH, Parwani AV, Pantanowitz L. Review of advanced imaging techniques. J Pathol Inform 2012; 3:22. [PMID: 22754737 PMCID: PMC3385156 DOI: 10.4103/2153-3539.96751] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 04/28/2012] [Indexed: 12/20/2022] Open
Abstract
Pathology informatics encompasses digital imaging and related applications. Several specialized microscopy techniques have emerged which permit the acquisition of digital images (“optical biopsies”) at high resolution. Coupled with fiber-optic and micro-optic components, some of these imaging techniques (e.g., optical coherence tomography) are now integrated with a wide range of imaging devices such as endoscopes, laparoscopes, catheters, and needles that enable imaging inside the body. These advanced imaging modalities have exciting diagnostic potential and introduce new opportunities in pathology. Therefore, it is important that pathology informaticists understand these advanced imaging techniques and the impact they have on pathology. This paper reviews several recently developed microscopic techniques, including diffraction-limited methods (e.g., confocal microscopy, 2-photon microscopy, 4Pi microscopy, and spatially modulated illumination microscopy) and subdiffraction techniques (e.g., photoactivated localization microscopy, stochastic optical reconstruction microscopy, and stimulated emission depletion microscopy). This article serves as a primer for pathology informaticists, highlighting the fundamentals and applications of advanced optical imaging techniques.
Collapse
Affiliation(s)
- Yu Chen
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | | | | | | | | | | |
Collapse
|
33
|
Probe-based confocal laser endomicroscopy evaluation of colon preneoplastic lesions, with particular attention to the aberrant crypt foci, and comparative assessment with histological features obtained by conventional endoscopy. Gastroenterol Res Pract 2012; 2012:645173. [PMID: 22566999 PMCID: PMC3328946 DOI: 10.1155/2012/645173] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 01/12/2012] [Accepted: 01/13/2012] [Indexed: 01/03/2023] Open
Abstract
The colorectal carcinoma represents one of the most common and aggressive malignancies, still characterized by an unacceptable mortality rate, mainly due to the high metastatic potential and to a late diagnosis. In the last years, the research community focused on the chance of improving the endoscopic screening to detect neoplastic lesions in a very early stage. Several studies proposed aberrant colonic crypt foci as the earliest recognizable step of transformation in colonic multiphase carcinogenesis. We previously demonstrated the clinical applicability and predictive power of probe-based confocal laser endoscopy (pCLE) in superficial colorectal neoplastic lesions and also characterized in vivo a case of dysplasia-associated lesional mass (DALM) in ulcerative colitis. Now, we aim to evaluate the accuracy of pCLE in the detection of ACF comparing in double-blind manner the microendoscopic and histopathological features resulting from colonic biopsy. By pCLE, we identified specific crypt architecture modifications associated with changes in cellular infiltration and vessels architecture, highlighting a good correspondence between pCLE features and histology.
Collapse
|
34
|
Perry SW, Burke RM, Brown EB. Two-photon and second harmonic microscopy in clinical and translational cancer research. Ann Biomed Eng 2012; 40:277-91. [PMID: 22258888 DOI: 10.1007/s10439-012-0512-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 01/09/2012] [Indexed: 11/30/2022]
Abstract
Application of two-photon microscopy (TPM) to translational and clinical cancer research has burgeoned over the last several years, as several avenues of pre-clinical research have come to fruition. In this review, we focus on two forms of TPM-two-photon excitation fluorescence microscopy, and second harmonic generation microscopy-as they have been used for investigating cancer pathology in ex vivo and in vivo human tissue. We begin with discussion of two-photon theory and instrumentation particularly as applicable to cancer research, followed by an overview of some of the relevant cancer research literature in areas that include two-photon imaging of human tissue biopsies, human skin in vivo, and the rapidly developing technology of two-photon microendoscopy. We believe these and other evolving two-photon methodologies will continue to help translate cancer research from the bench to the bedside, and ultimately bring minimally invasive methods for cancer diagnosis and treatment to therapeutic reality.
Collapse
Affiliation(s)
- Seth W Perry
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14627, USA.
| | | | | |
Collapse
|