|
1
|
Gallagher G, Malallah R, Epperlein JP, Dalli J, Hardy N, Jindal A, MacAonghusa PG, Cahill RA. A novel flexible near-infrared endoscopic device that enables real-time artificial intelligence fluorescence tissue characterization. PLoS One 2025; 20:e0317771. [PMID: 40080492 PMCID: PMC11906065 DOI: 10.1371/journal.pone.0317771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 01/03/2025] [Indexed: 03/15/2025] Open
Abstract
Real-time endoscopic rectal lesion characterization employing artificial intelligence (AI) and near-infrared (NIR) imaging of the fluorescence perfusion indicator agent Indocyanine Green (ICG) has demonstrated promise. However, commercially available fluorescence endoscopes do not possess the flexibility and anatomical reach capabilities of colonoscopy while commercial flexible scopes do not yet provide beyond visible spectral imaging. This limits the application of this AI-NIR classification technology. Here, to close this technical gap, we present our development of a colonoscope-compatible flexible imaging probe for NIR-ICG visualization combined with a full field of view machine learning (ML) algorithm for fluorescence quantification and perfusion pattern cross-correlation (including first in human testing). The imaging probe is capable of 133µm minimum object resolution, with a maximum working distance of 50mm and an excitation illumination power of 52mW with 75o average field of illumination (meaning minimum device tip distance from target is 13 mm for a 2 cm polyp). The system demonstrated ex-vivo and in-vivo NIR visualization of clinically relevant concentrations of ICG in both resected and in situ (extracorporeally) colon in patients undergoing colorectal resection. A previously developed AI-NIR perfusion quantification algorithm was applied to videos of a bench model of varying ICG flow captured with the developed flexible system with added ML features generated full field of view pixel-level fluorescence time-series measurements capable of distinguishing distinct ICG flow regions in the image via correlative dynamic fluorescence intensity profiles. Jaccard Index comparison of the AI -generated flow regions against manually delineated flow regions resulted in 79% accuracy. While further clinical validation of the AI-NIR polyp classification method is on-going (in the Horizon Europe Awarded CLASSICA project), other use case applications of NIR colonoscopy include simpler perioperative perfusion assessment in patients undergoing colorectal resection and combination with targeted agents in development thus encouraging continuing development and design optimization of this flexible NIR imaging probe to enable clinical and commercial translation.
Collapse
Affiliation(s)
- Gareth Gallagher
- School of Medicine, The Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
| | - Ra’ed Malallah
- School of Medicine, The Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
- Physics Department, Faculty of Science, University of Basrah, Garmat Ali, Basrah, Iraq
| | | | - Jeffrey Dalli
- School of Medicine, The Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
| | - Niall Hardy
- School of Medicine, The Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
| | - Abhinav Jindal
- School of Medicine, The Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
| | | | - Ronan A. Cahill
- School of Medicine, The Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
| |
Collapse
|
|
2
|
Current Status and Future Perspectives of Artificial Intelligence in Colonoscopy. J Clin Med 2022; 11:jcm11102923. [PMID: 35629049 PMCID: PMC9143862 DOI: 10.3390/jcm11102923] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 12/19/2022] Open
Abstract
The early endoscopic identification, resection, and treatment of precancerous adenoma and early-stage cancer has been shown to reduce not only the prevalence of colorectal cancer but also its mortality rate. Recent advances in endoscopic devices and imaging technology have dramatically improved our ability to detect colorectal lesions and predict their pathological diagnosis. In addition to this, rapid advances in artificial intelligence (AI) technology mean that AI-related research and development is now progressing in the diagnostic imaging field, particularly colonoscopy, and AIs (i.e., devices that mimic cognitive abilities, such as learning and problem-solving) already approved as medical devices are now being introduced into everyday clinical practice. Today, there is an increasing expectation that sophisticated AIs will be able to provide high-level diagnostic performance irrespective of the level of skill of the endoscopist. In this paper, we review colonoscopy-related AI research and the AIs that have already been approved and discuss the future prospects of this technology.
Collapse
|
|
3
|
Kudo SE, Mori Y, Abdel-Aal UM, Misawa M, Itoh H, Oda M, Mori K. Artificial intelligence and computer-aided diagnosis for colonoscopy: where do we stand now? Transl Gastroenterol Hepatol 2021; 6:64. [PMID: 34805586 DOI: 10.21037/tgh.2019.12.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/12/2019] [Indexed: 12/22/2022] Open
Abstract
Computer-aided diagnosis (CAD) for colonoscopy with use of artificial intelligence (AI) is catching increased attention of endoscopists. CAD allows automated detection and pathological prediction, namely optical biopsy, of colorectal polyps during real-time endoscopy, which help endoscopists avoid missing and/or misdiagnosing colorectal lesions. With the increased number of publications in this field and emergence of the AI medical device that have already secured regulatory approval, CAD in colonoscopy is now being implemented into clinical practice. On the other side, drawbacks and weak points of CAD in colonoscopy have not been thoroughly discussed. In this review, we provide an overview of CAD for optical biopsy of colorectal lesions with a particular focus on its clinical applications and limitations.
Collapse
Affiliation(s)
- Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Usama M Abdel-Aal
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.,Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hayato Itoh
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Masahiro Oda
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Kensaku Mori
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
| |
Collapse
|
|
4
|
Kato T, Iwasaki T, Arihiro S, Saruta M. Endoscopic visualization of cancer and dysplasia in patients with ulcerative colitis following sensitization with oral 5-aminolevulinic acid. J Dig Dis 2020; 21:498-504. [PMID: 32686910 PMCID: PMC7590119 DOI: 10.1111/1751-2980.12923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/22/2020] [Accepted: 07/05/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Early diagnosis of colitis-associated cancer and dysplasia through surveillance endoscopy is vital for patients with ulcerative colitis (UC). This study aimed to evaluate the efficacy of autofluorescence endoscopy (AFE) using 5-aminolevulinic acid (ALA) and to investigate the fluorescence signal localization pattern following 5-ALA administration in tumorous lesions diagnosed as colitis-associated cancer and dysplasia. The sensitivity and specificity of tumorous lesions detected by white light endoscopy (WLE) with and without AFE were evaluated. METHODS Overall, 13 endoscopic procedures were performed in 11 patients with UC using WLE and AFE following the oral administration of 5-ALA. The biopsied lesions detected via endoscopy and resected specimens from cases underwent colectomy were assessed histopathologically. The sensitivity and specificity of detecting tumorous lesions by WLE with and without AFE were evaluated. RESULTS Of the 68 lesions detected and biopsied, 63 were detected via WLE, and five were detected via AFE alone. The sensitivity of detecting colitis-associated cancer and dysplasia via WLE combined with AFE was 36.4%, and the specificity, positive predictive value and negative predictive value were 94.2%, 57.1%, and 87.5%, respectively. Tumorous lesions displayed three types of fluorescence patterns on AFE. CONCLUSIONS AFE using 5-ALA can detect colitis-associated cancer and dysplasia in patients with long-standing UC and lesions that could not be detected via WLE. The distinctive fluorescence patterns in lesions may permit qualitative diagnoses of colitis-associated cancer and dysplasia.
Collapse
Affiliation(s)
- Tomohiro Kato
- Division of Gastroenterology and Hepatology, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Tetsuyoshi Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Seiji Arihiro
- Division of Gastroenterology and Hepatology, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| |
Collapse
|
|
5
|
Sánchez-Montes C, García-Rodríguez A, Córdova H, Pellisé M, Fernández-Esparrach G. Advanced endoscopy technologies to improve the detection and characterisation of colorrectal polyps. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 43:46-56. [PMID: 31813615 DOI: 10.1016/j.gastrohep.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/20/2019] [Accepted: 09/13/2019] [Indexed: 11/19/2022]
Abstract
Colorectal cancer is a major health problem. An improvement to its survival has been demonstrated by performing colonoscopy screenings and removing its precursor lesions: polyps. However, colonoscopy is not infallible and multiple strategies have been proposed aimed at improving the quality thereof. This report describes the endoscopic systems available to improve the detection and characterization of polyps, the different classifications for histological prediction and the current indications of advanced endoscopic diagnostic techniques.
Collapse
Affiliation(s)
- Cristina Sánchez-Montes
- Unidad de Endoscopia Digestiva, Hospital Universitari i Politècnic La Fe, Grupo de Investigación de Endoscopia Digestiva, IIS La Fe, Valencia, España
| | - Ana García-Rodríguez
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - María Pellisé
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España.
| |
Collapse
|
|
6
|
Vinsard DG, Mori Y, Misawa M, Kudo SE, Rastogi A, Bagci U, Rex DK, Wallace MB. Quality assurance of computer-aided detection and diagnosis in colonoscopy. Gastrointest Endosc 2019; 90:55-63. [PMID: 30926431 DOI: 10.1016/j.gie.2019.03.019] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/18/2019] [Indexed: 02/05/2023]
Abstract
Recent breakthroughs in artificial intelligence (AI), specifically via its emerging sub-field "deep learning," have direct implications for computer-aided detection and diagnosis (CADe and/or CADx) for colonoscopy. AI is expected to have at least 2 major roles in colonoscopy practice-polyp detection (CADe) and polyp characterization (CADx). CADe has the potential to decrease the polyp miss rate, contributing to improving adenoma detection, whereas CADx can improve the accuracy of colorectal polyp optical diagnosis, leading to reduction of unnecessary polypectomy of non-neoplastic lesions, potential implementation of a resect-and-discard paradigm, and proper application of advanced resection techniques. A growing number of medical-engineering researchers are developing both CADe and CADx systems, some of which allow real-time recognition of polyps or in vivo identification of adenomas, with over 90% accuracy. However, the quality of the developed AI systems as well as that of the study designs vary significantly, hence raising some concerns regarding the generalization of the proposed AI systems. Initial studies were conducted in an exploratory or retrospective fashion by using stored images and likely overestimating the results. These drawbacks potentially hinder smooth implementation of this novel technology into colonoscopy practice. The aim of this article is to review both contributions and limitations in recent machine-learning-based CADe and/or CADx colonoscopy studies and propose some principles that should underlie system development and clinical testing.
Collapse
Affiliation(s)
- Daniela Guerrero Vinsard
- Showa University International Center for Endoscopy, Showa University Northern Yokohama Hospital, Yokohama, Japan; Division of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Amit Rastogi
- Division of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas
| | - Ulas Bagci
- Center for Research in Computer Vision, University of Central Florida, Orlando, Florida
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
|
7
|
Moriichi K, Fujiya M, Kobayashi Y, Murakami Y, Iwama T, Kunogi T, Sasaki T, Ijiri M, Takahashi K, Tanaka K, Sakatani A, Ando K, Nomura Y, Ueno N, Kashima S, Ikuta K, Tanabe H, Mizukami Y, Saitoh Y, Okumura T. Autofluorescence Imaging Reflects the Nuclear Enlargement of Tumor Cells as well as the Cell Proliferation Ability and Aberrant Status of the p53, Ki-67, and p16 Genes in Colon Neoplasms. Molecules 2019; 24:1106. [PMID: 30897785 PMCID: PMC6471796 DOI: 10.3390/molecules24061106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Autofluorescence imaging (AFI) is useful for diagnosing colon neoplasms, but what affects the AFI intensity remains unclear. This study investigated the association between AFI and the histological characteristics, aberrant methylation status, and aberrant expression in colon neoplasms. METHODS Fifty-three patients with colorectal neoplasms who underwent AFI were enrolled. The AFI intensity (F index) was compared with the pathological findings and gene alterations. The F index was calculated using an image analysis software program. The pathological findings were assessed by the tumor crypt density, cell densities, and N/C ratio. The aberrant methylation of p16, E-cadherin, Apc, Runx3, and hMLH1 genes was determined by a methylation-specific polymerase chain reaction. The aberrant expression of p53 and Ki-67 was evaluated by immunohistochemical staining. RESULTS An increased N/C ratio, the aberrant expression of p53, Ki-67, and the altered methylation of p16 went together with a lower F index. The other pathological findings and the methylation status showed no association with the F index. CONCLUSIONS AFI reflects the nuclear enlargement of tumor cells, the cell proliferation ability, and the altered status of cell proliferation-related genes, indicating that AFI is a useful and practical method for predicting the dysplastic grade of tumor cells and cell proliferation.
Collapse
Affiliation(s)
- Kentaro Moriichi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Yu Kobayashi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Yuki Murakami
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Takuya Iwama
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Takehito Kunogi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Takahiro Sasaki
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Masami Ijiri
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Keitaro Takahashi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Kazuyuki Tanaka
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Aki Sakatani
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Katsuyoshi Ando
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Yoshiki Nomura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Nobuhiro Ueno
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Shin Kashima
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Katsuya Ikuta
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Hiroki Tanabe
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Yusuke Mizukami
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| | - Yusuke Saitoh
- Digestive Disease Center, Asahikawa City Hospital, Asahikawa 070-8610, Japan.
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8510, Japan.
| |
Collapse
|
|
8
|
Strzelczyk N, Kwiatek S, Latos W, Sieroń A, Stanek A. Does the Numerical Colour Value (NCV) correlate with preneoplastic and neoplastic colorectal lesions? Photodiagnosis Photodyn Ther 2018; 23:353-361. [PMID: 30055281 DOI: 10.1016/j.pdpdt.2018.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND White light endoscopy (WLE) is the gold standard for detection of colorectal cancer. Autofluorescence endoscopy (AFE) is among the novel methods expected to increase the sensitivity and specificity of endoscopic diagnosis. The main objective of the study was to determine the diagnostic efficacy of AFE for the detection of preneoplastic and neoplastic colorectal lesions and to identify high-grade neoplasia using Numerical Colour Value (NCV). METHODS This retrospective study included 188 patients with colorectal mucosal lesions diagnosed on WLE and assessed using AFE; they were included in the study if a complete patient record was available (description of visualized colorectal lesions, NCV and histopathology report). The NCV was compared with the histological result. RESULTS Histology revealed 38 hyperplastic colon polyps, 77 low-grade dysplastic lesions, 17 high-grade dysplastic lesions, 24 adenocarcinomas and 32 inflammatory lesions. The mean NCVs of high-grade dysplasia (HGD) and adenocarcinoma were 2.24 ± 0.22 and 2.73 ± 0.16, respectively, significantly higher than the NCV of hyperplastic colon polyps (0.95 ± 0.06), low-grade dysplasia (LGD) (1.27 ± 0.05) and inflammatory lesions (1.26 ± 0.17). The NCV cut-off value for HGD and adenocarcinoma was set at 1.7. The sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) were 95.2%, 87.9%, 97.5%, 84.8%, respectively. CONCLUSION Our study showed that AFE could provide useful diagnostic information regarding preneoplastic and neoplastic colorectal lesions. Additionally, the NCV significantly correlated with the histopathology results.
Collapse
Affiliation(s)
- Natalia Strzelczyk
- Specialist Hospital No 2, Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnosis and Therapy, Batorego Street 15, 41-902 Bytom, Poland
| | - Sebastian Kwiatek
- Specialist Hospital No 2, Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnosis and Therapy, Batorego Street 15, 41-902 Bytom, Poland
| | - Wojciech Latos
- Specialist Hospital No 2, Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnosis and Therapy, Batorego Street 15, 41-902 Bytom, Poland
| | - Aleksander Sieroń
- School of Medicine with the Division of Dentistry in Zabrze, Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnosis and Therapy, Medical University of Silesia, Batorego Street 15, 41-902 Bytom, Poland
| | - Agata Stanek
- School of Medicine with the Division of Dentistry in Zabrze, Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnosis and Therapy, Medical University of Silesia, Batorego Street 15, 41-902 Bytom, Poland.
| |
Collapse
|
|
9
|
Ohsaki Y, Sasaki T, Endo S, Kitada M, Okumura S, Hirai N, Kazebayashi Y, Toyoshima E, Yamamoto Y, Takeyama K, Nakajima S, Sakata I. Observation of Zn-photoprotoporphyrin red Autofluorescence in human bronchial cancer using color-fluorescence endoscopy. BMC Cancer 2017; 17:289. [PMID: 28441937 PMCID: PMC5405517 DOI: 10.1186/s12885-017-3277-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/12/2017] [Indexed: 11/13/2022] Open
Abstract
Background We observed red autofluorescence emanating from bronchial cancer lesions using a sensitive color-fluorescence endoscopy system. We investigated to clarify the origin of the red autofluorescence. Methods The wavelengths of the red autofluorescence emanating from lesions were measured in eight patients using a spectrum analyzer and compared based on pathologic findings. Red autofluorescence at 617.3, 617.4, 619.0, and 617.1 nm was emitted by normal bronchus, inflamed tissue, tissue exhibiting mild dysplasia, and malignant lesions, respectively. Protoporphyrin, uroporphyrin, and coproporphyrin, the major porphyrin derivatives in human blood, were purchased to determine which porphyrin derivative is the source of red fluorescence when acquired de novo. We synthesized photoporphyrin, Zn-protoporphyrin and Zn-photoprotoporphyrin from protoporphyrin. Results Coproporphyrin and uroporphyrin emitted only weak fluorescence. Fluorescence was emitted by our synthesized Zn-photoprotoporphyrin at 625.5 nm and by photoprotoporphyrin at 664.0 nm. Conclusions From these results, we conclude that Zn-photoprotoporphyrin was the source of the red autofluorescence observed in bronchial lesions. Zn-protoporphyrin is converted to Zn-photoprotoporphyrin by radiation with excitation light. Our results suggest that red autofluorescence emanating from Zn-photoprotoporphyrin in human tissues could interfere with photodynamic diagnosis using porphyrin derivatives such as Photofrin® and Lazerphyrin® with a sensitive endoscopy system, because color cameras cannot differentiate Zn-photoprotoporphyrin red fluorescence from that of other porphyrin derivatives.
Collapse
Affiliation(s)
- Yoshinobu Ohsaki
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
| | - Takaaki Sasaki
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Satoshi Endo
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Masahiro Kitada
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shunsuke Okumura
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Noriko Hirai
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Yoshihiro Kazebayashi
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Eri Toyoshima
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Yasushi Yamamoto
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Kaneyoshi Takeyama
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Susumu Nakajima
- Moriyama Memorial Hospital, Asahimachi 2-1-31, Asahikawa, 070-0832, Japan
| | - Isao Sakata
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.,Porphyrin Lab, Okayama, 700-0086, Japan
| |
Collapse
|
|
10
|
Zheng X, Xiong H, Li Y, Han B, Sun J. RGB and HSV quantitative analysis of autofluorescence bronchoscopy used for characterization and identification of bronchopulmonary cancer. Cancer Med 2016; 5:3023-3030. [PMID: 27709786 PMCID: PMC5119956 DOI: 10.1002/cam4.831] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 06/02/2016] [Accepted: 06/13/2016] [Indexed: 01/11/2023] Open
Abstract
Autofluorescence bronchoscopy (AFB) shows good sensitivity in detecting dysplasia and bronchopulmonary cancer. However, the poor specificity of AFB would lead to excessive biopsy. The aim of the study is to establish a more effective quantitative method (optimal identification index and reference value) for characterizing the AFB images within the region of interest and discuss AFB's significance in the diagnosis of central‐type lung cancer. A total of 218 suspected lung cancer patients were enrolled in this study. A quantitative analysis based on color space (red, green, blue[RGB] and HSV system) was conducted and the result was compared with the final diagnosis obtained by the pathology of biopsy. Cases were divided into different groups according to the pathological diagnosis of normal bronchial mucosa, inflammation, low‐grade preinvasive (LGD), high‐grade preinvasive (HGD), and invasive cancer. Quantitative analyses in multi‐color spaces for the lesions showed by AFB images were conducted by software MATLAB. Finally, there is statistical significance among the different groups in some parameter in RGB and HSV system. So, both RGB and HSV quantitative analysis of autofluorescence bronchoscopy are useful to define benign and malignant diseases, which can objectively guide the bronchoscopist in selecting sites for biopsy with good pathologic correlation.
Collapse
Affiliation(s)
- Xiaoxuan Zheng
- Department of Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Hongkai Xiong
- Department of Electronic Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yong Li
- Department of Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Baohui Han
- Department of pulmonary medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jiayuan Sun
- Department of Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| |
Collapse
|
|
11
|
Zheng X, Xiong H, Li Y, Han B, Sun J. Application of Quantitative Autofluorescence Bronchoscopy Image Analysis Method in Identifying Bronchopulmonary Cancer. Technol Cancer Res Treat 2016; 16:482-487. [PMID: 27436838 DOI: 10.1177/1533034616656466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Autofluorescence bronchoscopy shows good sensitivity and poor specificity in detecting dysplasia and cancer of the bronchus. Through quantitative analysis on the target area of autofluorescence bronchoscopy image, determine the optimal identification index and reference value for identifying different types of diseases and explore the value of autofluorescence bronchoscopy in diagnosis of lung cancer. Patients with 1 or more preinvasive bronchial lesions were enrolled and followed up by white-light bronchoscope and autofluorescence bronchoscopy. Color space quantitative image analysis was conducted on the lesion shown in the autofluorescence image using MATLAB image measurement software. A retrospective analysis was conducted on 218 cases with 1208 biopsies. One hundred seventy-three cases were diagnosed as positive, which included 151 true-positive cases and 22 false-positive cases. White-light bronchoscope associated with autofluorescence bronchoscopy was able to differentiate between benign and malignant lesion with a high sensitivity, specificity, positive predictive value, and negative predictive value (92.1%, 59.3%, 87.3%, and 71.1%, respectively). Taking 1.485 as the cutoff value of receiver operating characteristic of red-to-green value to differentiate benign and malignant diseases, the diagnostic sensitivity reached 82.3% and the specificity reached 80.5%. U values could differentiate invasive carcinoma and other groups well. Quantitative image analysis method of autofluorescence bronchoscopy provided effective scientific basis for the diagnosis of lung cancer and precancerous lesions.
Collapse
Affiliation(s)
- Xiaoxuan Zheng
- 1 Department of Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hongkai Xiong
- 2 Department of Electronic Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Li
- 2 Department of Electronic Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Baohui Han
- 3 Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiayuan Sun
- 1 Department of Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
|
12
|
Tamai N, Inomata H, Ide D, Dobashi A, Saito S, Sumiyama K. Effectiveness of color intensity analysis using updated autofluorescence imaging systems for serrated lesions. Dig Endosc 2016; 28 Suppl 1:49-52. [PMID: 26748839 DOI: 10.1111/den.12602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM We previously reported the effectiveness of color intensity analysis using autofluorescence imaging (AFI) for differentiating colorectal neoplastic lesions from non-neoplastic lesions. However, the ability of AFI systems for differentiating serrated lesions has not been evaluated. In the present study, we assessed the effectiveness of color intensity analysis using updated AFI systems for evaluating serrated lesions. METHODS We retrospectively reviewed the data for 48 consecutive patients with 87 serrated lesions that were examined using updated AFI systems and resected at Jikei University Hospital. The mean green/red (G/R) ratio, which is obtained by dividing the mean green color intensities by the mean red color intensities, was calculated for each serrated lesion and compared between hyperplastic polyps, sessile serrated adenomas/polyps (SSA/P) with cytological dysplasia, and SSA/P without cytological dysplasia. We also assessed the area under the receiver operating characteristic curve (AUC) for determining SSA/P (both with and without cytological dysplasia) and SSA/P with cytological dysplasia. RESULTS The AUC for determining SSA/P was 0.68; however, the AUC for determining SSA/P with cytological dysplasia was 0.97. With a cut-off for the G/R ratio of <0.93, the sensitivity, specificity, positive predictive value, and negative predictive value for SSA/P with cytological dysplasia were 95.5%, 91.0%, 77.8%, and 98.3%, respectively. CONCLUSION Color intensity analysis of serrated lesions using updated AFI systems could effectively distinguish SSA/P with cytological dysplasia from hyperplastic polyps and SSA/P without cytological dysplasia.
Collapse
Affiliation(s)
- Naoto Tamai
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroko Inomata
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Daisuke Ide
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoichi Saito
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
|
13
|
Saito S, Tajiri H, Ikegami M. Endoscopic features of submucosal deeply invasive colorectal cancer with NBI characteristics : S Saito et al. Endoscopic images of early colorectal cancer. Clin J Gastroenterol 2015; 8:353-9. [PMID: 26661443 DOI: 10.1007/s12328-015-0616-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 10/30/2015] [Indexed: 02/08/2023]
Abstract
In this review, we discuss the features of conventional endoscopy, magnified endoscopy involving image enhanced endoscopy and endoscopic ultrasonography (EUS) using illustrations for submucosal deeply invasive colorectal cancer (SM-Ca). First, the typical features of SM-Ca were observed, including fold convergence, stiffness, depression (ulceration) and elevated lesions in depressed areas. Magnified endoscopic findings using NBI showed dilated, irregularly shaped micro-capillary vessels. In addition, VI and VN pits were clearly visible using crystal violet staining. In contrast, using EUS, at the third layer we found a layer that was thin compared to the surrounding normal mucosa, which suggested the existence of SM-Ca.
Collapse
Affiliation(s)
- Shoichi Saito
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi Minato-Ku, Tokyo, 105-8461, Japan.
| | - Hisao Tajiri
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi Minato-Ku, Tokyo, 105-8461, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Ikegami
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
|
14
|
Kaise M. Advanced endoscopic imaging for early gastric cancer. Best Pract Res Clin Gastroenterol 2015; 29:575-87. [PMID: 26381303 DOI: 10.1016/j.bpg.2015.05.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/22/2015] [Accepted: 05/21/2015] [Indexed: 01/31/2023]
Abstract
Considerable numbers of early gastric cancers can be missed or misdiagnosed with conventional white light imaging endoscopy (WLI), thus advanced endoscopic imaging modalities have been applied to overcome the issue. High definition endoscopy can improve diagnostic accuracy, but still misses 20-25% of early gastric cancer. Magnifying endoscopy combined with narrow band imaging (NBI) allows for very high accuracy, with sensitivity and specificity of over 95%. The algorithm for magnifying endoscopy diagnosis of gastric cancer is composed of 1) presence of demarcation line, and 2) presence of irregular microsurface and/or microvascular pattern. Ultra-high magnification of 400 times with endocytoscopy (ECS) can produce images reflecting structural and cellular atypia. Using high grade ECS atypia as the diagnostic criteria for gastric cancer, ECS achieves a high diagnostic accuracy (86% of sensitivity, 100% of specificity) although approximately 10% of target lesions are not assessable because of poor dye staining.
Collapse
Affiliation(s)
- Mitsuru Kaise
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan.
| |
Collapse
|
|
15
|
Saito S, Tajiri H, Ikegami M. Serrated polyps of the colon and rectum: Endoscopic features including image enhanced endoscopy. World J Gastrointest Endosc 2015; 7:860-871. [PMID: 26240687 PMCID: PMC4515420 DOI: 10.4253/wjge.v7.i9.860] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/29/2014] [Accepted: 06/16/2015] [Indexed: 02/05/2023] Open
Abstract
In this review, I outline the characteristic endoscopic findings of serrated lesions of the colorectum based on image enhanced endoscopy (IEE). Histopathologically, lesions with serrated structures are typically classified into the following three types based: hyperplastic polyps (HPs), traditional serrated adenomas (TSAs), and sessile serrated adenoma/polyps (SSA/Ps). Both HP and SSA/P often present as dark-green colors on auto fluorescence imaging (AFI) colonoscopy that are similar to the normal surrounding mucosa. In contrast, TSAs often have elevated shapes and present as magenta colors that are similar to the tubular adenomas. The superficial type of TSA also includes many lesions that present as magenta colors. When SSA/Ps are associated with cytological dysplasia, many lesions present with magenta colors, whereas lesions that are not associated with cytological dysplasia present with dark-green colors. When observed via narrow band imaging (NBI), many SSA/P include lesions with strong mucous adhesions. Because these lesions are observed with reddish mucous adhesions, we refer to them as “red cap sign” and place such signs among the typical findings of SSA/P. Because the dilatation of the pit in SSA/P is observed as a round/oval black dot on magnified observations, we refer to this finding as II-dilatation pit (II-D pit) and also positioned it as a characteristic finding of SSA/P. In contrast, dilatations of the capillary vessels surrounding the glands, such as those that occur in tubular adenoma, are not considered to be useful for differentiating HPs from SSA/Ps. However, in cases in which SSA/P is associated with cytological dysplasia, the dilatation of capillary vessels is observed in the same area. When submucosal layer invasion occurs in the same area, the blood flow presents with irregularities that are similar to those of common colorectal cancer at an early stage and disappears as the invasion proceeds deeply. The surface pattern of invasive cancer that is observed at the tumor surface is also likely to disappear. Based on the above results, we considered that the differentiations between HP and TSA, between TSA and SSA/P, and between HP and SSA/P might become easier due to the concomitant use of white light observation and IEE. We also concluded that AFI and NBI can be useful modalities for SSA/P lesions associated with cytological dysplasia.
Collapse
|
|
16
|
Matsuda T, Kawano H, Chiu HM. Screening colonoscopy: what is the most reliable modality for the detection and characterization of colorectal lesions? Dig Endosc 2015; 27 Suppl 1:25-9. [PMID: 25630990 DOI: 10.1111/den.12451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/26/2015] [Indexed: 01/27/2023]
Abstract
Colonoscopy is considered the best modality for the detection and treatment of colorectal polyps. However, some polyps still may not be detected. Although conventional white-light endoscopy is the gold standard for the detection of colorectal polyps, up to a fifth of lesions may be missed on screening colonoscopy, especially non-polypoid colorectal neoplasms. Recently, many studies have reported on various endoscopic modalities that improve the detection and characterization of colorectal lesions. Newly developed modalities might be helpful to recognize colorectal lesions; however, careful observation is required to identify flat/depressed lesions as well as hidden polyps during screening and surveillance colonoscopy.
Collapse
Affiliation(s)
- Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | | |
Collapse
|
|
17
|
Zheng X, Xiong H, Li Y, Han B, Sun J. [Quantization Methodology of Autofluorescence Bronchoscopy Image
in the YUV System]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:797-803. [PMID: 25404270 PMCID: PMC6000354 DOI: 10.3779/j.issn.1009-3419.2014.11.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
背景与目的 通过对不同病理类型的自荧光气管镜（autofluorescence bronchoscope, AFB）图像目标区域的YUV定量分析，确定区分不同疾病类型的最佳判别指标，探讨AFB在中央型支气管肺癌诊断中的价值。 方法 对研究对象进行白光气管镜+AFB检查，二者在镜下存在异常者行活检。并对荧光图像显示病变部位通过MATLAB图像测量软件进行YUV定量分析。根据正常支气管粘膜、炎症、低级别上皮样瘤变、高级别上皮样瘤变、浸润性癌的病理结果分组。研究各组与YUV值间的关系，所得数据采用SPSS 11.5软件进行统计学处理。 结果 Y值在浸润性癌和LGD组间存在统计学差异（P=0.040），在浸润性癌和炎症组也存在明显统计学差异（P < 0.001）。其他的各组间无统计学差异。U值在浸润性癌和HGD、LGD、炎症、正常支气管粘膜组之间存在统计学差异（P < 0.050），能较好鉴别正常粘膜及恶性病变。V值在浸润性癌和LGD组（P=0.003）、炎症组（P < 0.001）、正常支气管粘膜组（P < 0.001）存在统计学差异，能有效鉴别浸润性癌及良性疾病。V值在正常支气管粘膜组与HGD组（P=0.001）、炎症组（P=0.004）间比较也具有统计学差异。 结论 利用YUV色彩空间系统针对支气管和肺良恶性疾病鉴别有一定临床应用价值，为临床气管镜诊断肺癌及癌前病变提供有效科学依据。
Collapse
Affiliation(s)
- Xiaoxuan Zheng
- Department of Endoscopy Room, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Hongkai Xiong
- Department of Electronic Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yong Li
- Department of Electronic Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jiayuan Sun
- Department of Endoscopy Room, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| |
Collapse
|
|
18
|
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: 30] [Impact Index Per Article: 2.7] [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
|
|
19
|
Matsuda T, Kawano H, Hisabe T, Ikematsu H, Kobayashi N, Mizuno K, Oka S, Takeuchi Y, Tamai N, Uraoka T, Hewett D, Chiu HM. Current status and future perspectives of endoscopic diagnosis and treatment of diminutive colorectal polyps. Dig Endosc 2014; 26 Suppl 2:104-108. [PMID: 24750158 DOI: 10.1111/den.12281] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/10/2014] [Indexed: 02/07/2023]
Abstract
During colonoscopy, small and diminutive colorectal polyps are commonly encountered. It is estimated that at least one adenomatous polyp is detected in almost half of all patients undergoing screening colonoscopy. In contrast, the 'predict, resect, and discard' strategy for diminutive and small colorectal polyps is a current topic especially in Western countries. 'Is this an acceptable policy in Japan?' Herein, we report the results of a questionnaire survey with regard to the management of diminutive colorectal polyps, including the thoughts of Japanese endoscopists regarding the 'predict, resect, and discard' strategy. At the moment, we propose that this strategy should be used by skilled endoscopists only.
Collapse
Affiliation(s)
- Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
20
|
Tamai N, Saito S, Aihara H, Kato T, Tajiri H. Evaluation of the effectiveness of color intensity analysis using a second-generation autofluorescence imaging system for diminutive colorectal polyp differentiation. Dig Endosc 2014; 26 Suppl 2:68-72. [PMID: 24750152 DOI: 10.1111/den.12246] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/10/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM We previously reported the effectiveness of color tone intensity analysis using autofluorescence imaging (AFI) for distinguishing between colorectal neoplastic and non-neoplastic lesions. Moreover, a second-generation AFI system has become commercially available in Japan. In the present study, we assessed the effectiveness of color tone intensity analysis using a second-generation AFI system for evaluating diminutive colorectal lesions. METHODS We retrospectively reviewed the cases of 35 consecutive patients with 101 diminutive colorectal lesions that were examined using a second-generation AFI system and resected at the Jikei University Hospital. We estimated the mean green-to-red (G/R) ratio - obtained by dividing the green color tone intensity by the red color tone intensity - of the lesions and compared the values of the neoplastic and non-neoplastic lesions. We also assessed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the AFI system for neoplastic lesion identification. RESULTS The mean G/R ratios of the non-neoplastic and neoplastic lesions were 1.06 and 0.87, respectively; the mean G/R ratio significantly differed between the neoplastic and non-neoplastic lesions. Using the second-generation AFI system, neoplastic lesions were identified with a sensitivity, specificity, PPV, and NPV of 94.2%, 91.8%, 92.5%, and 93.8%, respectively. CONCLUSION Color intensity analysis of diminutive colorectal polyps using the second generation AFI system could effectively distinguish between neoplastic and non-neoplastic lesions.
Collapse
Affiliation(s)
- Naoto Tamai
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | | | | |
Collapse
|
|
21
|
Subramanian V, Ragunath K. Advanced endoscopic imaging: a review of commercially available technologies. Clin Gastroenterol Hepatol 2014; 12:368-76.e1. [PMID: 23811245 DOI: 10.1016/j.cgh.2013.06.015] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 05/17/2013] [Accepted: 06/03/2013] [Indexed: 02/07/2023]
Abstract
The rapid strides made in innovative endoscopic technology to improve mucosal visualization have revolutionized endoscopy. Improved lesion detection has allowed the modern endoscopist to provide real-time optical diagnosis. Improvements in image resolution, software processing, and optical filter technology have resulted in the commercial availability of high-definition endoscopy as well as optical contrast techniques such as narrow-band imaging, flexible spectral imaging color enhancement, and i-scan. Along with autofluorescence imaging and confocal laser endomicroscopy, these techniques have complemented and enhanced traditional white light endoscopy. They have the potential to serve as red-flag techniques to improve detection of mucosal abnormalities as well as allow optical diagnosis and virtual histology of detected lesions. This review will focus on these emerging commercially available technologies and aims to provide an overview of the technologies, their clinical applicability, and current status.
Collapse
Affiliation(s)
- Venkataraman Subramanian
- Department of Gastroenterology, St James University Hospital and Leeds Institute of Molecular Medicine, University of Leeds, Leeds
| | - Krish Ragunath
- Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospital, Nottingham, United Kingdom.
| |
Collapse
|
|
22
|
Saito Y, Gimeno-García A, Matsuda T, Nicolás-Pérez D, Uraoka T, Quintero E. New Imaging Modalities for Identification of Hidden Polyps. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-013-0206-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
|
23
|
Inomata H, Tamai N, Aihara H, Sumiyama K, Saito S, Kato T, Tajiri H. Efficacy of a novel auto-fluorescence imaging system with computer-assisted color analysis for assessment of colorectal lesions. World J Gastroenterol 2013; 19:7146-7153. [PMID: 24222959 PMCID: PMC3819551 DOI: 10.3748/wjg.v19.i41.7146] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/22/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of computer-assisted color analysis of colorectal lesions using a novel auto-fluorescence imaging (AFI) system to distinguish neoplastic lesions from non-neoplastic lesions and to predict the depth of invasion.
METHODS: From January 2013 to April 2013, consecutive patients with known polyps greater than 5 mm in size who were scheduled to undergo endoscopic treatment at The Jikei University Hospital were prospectively recruited for this study. All lesions were evaluated using a novel AFI system, and color-tone sampling was performed in a region of interest determined from narrow band imaging or from chromoendoscopy findings without magnification. The green/red (G/R) ratio for each lesion on the AFI images was calculated automatically using a computer-assisted color analysis system that permits real-time color analysis during endoscopic procedures.
RESULTS: A total of 88 patients with 163 lesions were enrolled in this study. There were significant differences in the G/R ratios of hyperplastic polyps (non-neoplastic lesions), adenoma/intramucosal cancer/submucosal (SM) superficial cancer, and SM deep cancer (P < 0.0001). The mean ± SD G/R ratios were 0.984 ± 0.118 in hyperplastic polyps and 0.827 ± 0.081 in neoplastic lesions. The G/R ratios of hyperplastic polyps were significantly higher than those of neoplastic lesions (P < 0.001). When a G/R ratio cut-off value of > 0.89 was applied to determine non-neoplastic lesions, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 83.9%, 82.6%, 53.1%, 95.6% and 82.8%, respectively. For neoplastic lesions, the mean G/R ratio was 0.834 ± 0.080 in adenoma/intramucosal cancer/SM superficial cancer and 0.746 ± 0.045 in SM deep cancer. The G/R ratio of adenoma/intramucosal cancer/SM superficial cancer was significantly higher than that of SM deep cancer (P < 0.01). When a G/R ratio cut-off value of < 0.77 was applied to distinguish SM deep cancers, the sensitivity, specificity, PPV, NPV, and accuracy were 80.0%, 84.4%, 29.6%, 98.1% and 84.1%, respectively.
CONCLUSION: The novel AFI system with color analysis was effective in distinguishing non-neoplastic lesions from neoplastic lesions and might allow determination of the depth of invasion.
Collapse
|
|
24
|
Banerjee B, Rial NS, Renkoski T, Graves LR, Reid SAH, Hu C, Tsikitis VL, Nfonsom V, Pugh J, Utzinger U. Enhanced visibility of colonic neoplasms using formulaic ratio imaging of native fluorescence. Lasers Surg Med 2013; 45:573-81. [PMID: 24114774 DOI: 10.1002/lsm.22186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Colonoscopy is the preferred method for colon cancer screening, but can miss polyps and flat neoplasms with low color contrast. The objective was to develop a new autofluorescence method that improves image contrast of colonic neoplasms. STUDY DESIGN/MATERIALS AND METHODS We selected the three strongest native fluorescence signals and developed a novel method where fluorescence images are processed in a ratiometric formula to represent the likely cellular and structural changes associated with neoplasia. Native fluorescence images of fresh surgical specimens of the colon containing normal mucosa, polypoid and flat adenomas as well as adenocarcinoma were recorded using a prototype multi-spectral imager. Sixteen patients, with a mean age of 62 years (range 28-81) undergoing elective resection for colonic neoplasms were enrolled. High contrast images were seen with fluorescence from tryptophan (Tryp), flavin adenine dinucleotide (FAD) and collagen. RESULTS When the image intensity of Tryp was divided pixel by pixel, by the intensities of FAD and collagen, the resulting formulaic ratio (FR) images were of exceptionally high contrast. The FR images of adenomas and adenocarcinomas had increased Weber contrast. CONCLUSIONS FR imaging is a novel imaging process that represents the likely metabolic and structural changes in colonic neoplasia that produces images with remarkably high contrast.
Collapse
Affiliation(s)
- Bhaskar Banerjee
- Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, 85724; Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, Arizona, 85721; College of Optical Sciences, University of Arizona, Tucson, Arizona, 85721
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
25
|
Computer-aided diagnosis of neoplastic colorectal lesions using 'real-time' numerical color analysis during autofluorescence endoscopy. Eur J Gastroenterol Hepatol 2013; 25:488-94. [PMID: 23249604 DOI: 10.1097/meg.0b013e32835c6d9a] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Differentiating non-neoplastic colorectal lesions from neoplastic lesions during screening colonoscopies is essential to reduce the unnecessary treatment of non-neoplastic lesions. The present study was conducted to verify the diagnostic yields of the computer-aided diagnostic system that enables 'real-time' color analysis of colorectal lesions when applied to autofluorescence endoscopy (AFE). PATIENTS AND METHODS Consecutive patients who were scheduled to undergo a therapeutic colonoscopy in our department were enrolled in this study. The encountered lesions were evaluated in AFE and color-tone sampling was performed. Lesions with green/red (G/R) ratios less than 1.01 were judged to be neoplastic and those with G/R ratios of at least 1.01 were considered to be non-neoplastic. All lesions greater than 5 mm were endoscopically removed and lesions less than 5 mm were biopsied. RESULTS During the study period, a total of 32 patients with 102 colorectal lesions were evaluated with AFE. The mean G/R ratio for all neoplastic lesions was 0.86 [95% confidence interval (CI), 0.63-1.01], which was significantly lower than the mean G/R ratio for non-neoplastic lesions (1.12; 95% CI, 0.98-1.26; P<0.001). The mean G/R ratios were 1.36 (95% CI, 1.21-1.57) in normal mucosa, 1.12 (95% CI, 0.98-1.26) in hyperplastic lesions, 0.88 (95% CI, 0.69-1.02) in adenomas, and 0.61 (95% CI, 0.54-0.73) in intramucosal cancers. A G/R ratio cutoff value of 1.01 was applied for discriminating between neoplastic lesions and non-neoplastic lesions, and yielded sensitivity, specificity, positive and negative predictive values of 94.2, 88.9, 95.6, and 85.2%, respectively. CONCLUSION This diagnostic tool may lead to the reduction of unnecessary treatments for non-neoplastic lesions.
Collapse
|
|
26
|
Rex DK. Management of small and diminutive polyps. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2013. [DOI: 10.1016/j.tgie.2013.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
|
27
|
Renkoski TE, Banerjee B, Graves LR, Rial NS, Reid SAH, Tsikitis VL, Nfonsam VN, Tiwari P, Gavini H, Utzinger U. Ratio images and ultraviolet C excitation in autofluorescence imaging of neoplasms of the human colon. JOURNAL OF BIOMEDICAL OPTICS 2013; 18:16005. [PMID: 23291657 PMCID: PMC3537599 DOI: 10.1117/1.jbo.18.1.016005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The accepted screening technique for colon cancer is white light endoscopy. While most abnormal growths (lesions) are detected by this method, a significant number are missed during colonoscopy, potentially resulting in advanced disease. Missed lesions are often flat and inconspicuous in color. A prototype ultraviolet spectral imager measuring autofluorescence (AF) and reflectance has been developed and applied in a study of 21 fresh human colon surgical specimens. Six excitation wavelengths from 280 to 440 nm and formulaic ratio imaging were utilized to increase lesion contrast and cause neoplasms to appear bright compared to normal tissue. It was found that in the subset of lesions which were most difficult to visualize in standard color photographs [low contrast lesions, (LCLs)] a ratio image (F340/F440) of AF images excited at 340 and 440 nm produced extraordinary images and was effective in about 70% of these difficult cases. Contrast may be due to increased levels of reduced nicotinamide adenine dinucleotide, increased hemoglobin absorption, and reduced signal from submucosal collagen. A second successful ratio image (R480/R555) combined two reflectance images to produce exceptional images especially in particular LCLs where F340/F440 was ineffective. The newly discovered ratio images can potentially improve detection rate in screening with a novel AF colonoscope.
Collapse
Affiliation(s)
- Timothy E. Renkoski
- University of Arizona, College of Optical Sciences, 1630 E. University Boulevard, Tucson, Arizona 85721
| | - Bhaskar Banerjee
- University of Arizona, College of Optical Sciences, 1630 E. University Boulevard, Tucson, Arizona 85721
- University of Arizona, Department of Medicine, Section of Gastroenterology, 1501 N. Campbell Avenue, P.O. Box 245028, Tucson, Arizona 85724-5028
- University of Arizona, Department of Biomedical Engineering, 1127 E. James E. Rogers Way, Tucson, Arizona 85721
| | - Logan R. Graves
- University of Arizona, College of Optical Sciences, 1630 E. University Boulevard, Tucson, Arizona 85721
| | - Nathaniel S. Rial
- University of Arizona, Department of Medicine, Section of Gastroenterology, 1501 N. Campbell Avenue, P.O. Box 245028, Tucson, Arizona 85724-5028
| | - Sirandon A. H. Reid
- University of Arizona, Department of Medicine, Section of Gastroenterology, 1501 N. Campbell Avenue, P.O. Box 245028, Tucson, Arizona 85724-5028
| | | | - Valentine N. Nfonsam
- University of Arizona, Department of Surgery, 1501 N. Campbell Avenue, Tucson, Arizona 85724
| | - Piyush Tiwari
- University of Arizona, Department of Medicine, Section of Gastroenterology, 1501 N. Campbell Avenue, P.O. Box 245028, Tucson, Arizona 85724-5028
| | - Hemanth Gavini
- University of Arizona, Department of Medicine, Section of Gastroenterology, 1501 N. Campbell Avenue, P.O. Box 245028, Tucson, Arizona 85724-5028
| | - Urs Utzinger
- University of Arizona, College of Optical Sciences, 1630 E. University Boulevard, Tucson, Arizona 85721
- University of Arizona, Department of Biomedical Engineering, 1127 E. James E. Rogers Way, Tucson, Arizona 85721
- Address all correspondence to: Urs Utzinger, University of Arizona, Department of Biomedical Engineering, 1127 E. James E. Rogers Way, Tucson, Arizona 85721. Tel: 520-621-5420; E-mail:
| |
Collapse
|
|
28
|
Moriichi K, Fujiya M, Sato R, Nata T, Nomura Y, Ueno N, Ishikawa C, Inaba Y, Ito T, Okamoto K, Tanabe H, Mizukami Y, Watari J, Saitoh Y, Kohgo Y. Autofluorescence imaging and the quantitative intensity of fluorescence for evaluating the dysplastic grade of colonic neoplasms. Int J Colorectal Dis 2012; 27:325-30. [PMID: 21979167 DOI: 10.1007/s00384-011-1311-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Autofluorescence imaging (AFI) is a novel technology which can capture fluorescence emitted from intestinal tissues. While AFI is useful for detecting colorectal neoplasms, it is unclear whether AFI can facilitate the diagnosis by differentiating the extent of dysplasia of colorectal neoplasms. This study investigated the efficacy of AFI in discriminating high-grade from low-grade adenoma. MATERIALS AND METHODS Sixty-seven patients who underwent colonoscopy with AFI were enrolled in this study. The AFI images obtained from 158 lesions in these patients were visually classified into four categories, namely, green (G), green with magenta spots (GM), magenta with green spots (MG), and magenta (M), according to their color intensities, immediately after the examination. The AFI images of the lesions were quantified using an image-analytical software program (F index). Either the F index or the visual assessment was prospectively compared with the dysplastic grade. RESULTS The F index of the high-grade adenomas was significantly lower than that of the low-grade adenomas, hyperplasia, and normal mucosa (p < 0.05). The incidence of the lesions classified into the M classification for high-grade adenomas (55.6%) was significantly higher than that of either low-grade adenomas (20.8%) or hyperplasia (0%). No correlation was observed between the F index or the visual classification and the tumor shape. The F index was not influenced by the size of the lesion, while the size was significantly associated with the visual classification of AFI. CONCLUSIONS AFI, particularly the F index, is considered to be a useful procedure for estimating the dysplastic grade of colonic adenomas.
Collapse
Affiliation(s)
- Kentaro Moriichi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1, Midorigaoka-higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
29
|
Application of autofluorescence endoscopy for colorectal cancer screening: rationale and an update. Gastroenterol Res Pract 2011; 2012:971383. [PMID: 22194739 PMCID: PMC3235582 DOI: 10.1155/2012/971383] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 09/17/2011] [Indexed: 02/07/2023] Open
Abstract
As the result of basic researches, several intravital fluorophores have been determined so far in human colorectal tissue. Autofluorescence endoscopy (AFE) can detect slight alterations in their distribution and concentration during the colorectal carcinogenesis process and, thus facilitate noninvasive screening colonoscopies without the need for fluorescent substances or staining reagents to be administered. While detecting faint autofluorescence intensity by conventional fiberoptic endoscopy remains challenging, the latest AFE system with high-resolution videoendoscope capabilities enables such detection by using a false-color display algorithm. To this end, the diagnostic benefits of AFE have been reported in several multicenter randomized controlled studies of colorectal cancer (CRC) screening and differential diagnosis. CRC screening using the latest AFE technology could, therefore, lead to future reductions in CRC mortality.
Collapse
|
|
30
|
Song LMWK, Banerjee S, Desilets D, Diehl DL, Farraye FA, Kaul V, Kethu SR, Kwon RS, Mamula P, Pedrosa MC, Rodriguez SA, Tierney WM. Autofluorescence imaging. Gastrointest Endosc 2011; 73:647-50. [PMID: 21296349 DOI: 10.1016/j.gie.2010.11.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 11/04/2010] [Indexed: 02/07/2023]
|
|
31
|
Imaging by Magnifying Endoscopy with NBI Implicates the Remnant Capillary Network As an Indication for Endoscopic Resection in Early Colon Cancer. Int J Surg Oncol 2011; 2011:242608. [PMID: 22312499 PMCID: PMC3263659 DOI: 10.1155/2011/242608] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 12/11/2010] [Indexed: 12/13/2022] Open
Abstract
Introduction. This study examined whether magnifying endoscopy with NBI observation (ME-NBI) could be useful selecting the appropriate treatment for submucosal invasive cancer (SM cancer). Patients and Methods. We analyzed 515 cases of colon tumors excised endoscopically or surgically. We classified capillary network pattern into four types according to the degree of dilatation, irregularity, and distribution of microcapillary features. Results. The comparison of capillary pattern and histological features revealed microcapillary networks by using confocal laser-scanning microscopy and ME-NBI in intramucosal lesion or SM cancer with remnant neoplastic glands at the superficial layer. In contrast, the network was absent in SM cancer with desmoplastic reactions, which invaded deeper into the submucosal layer. Conclusions. The remaining microcapillary network is designed to maintain the architecture of neoplastic glands. Consequently, loss of this network could correlate with depth of tumor invasion and desmoplastic reaction. Therefore, we can decide the appropriate treatment by using ME-NBI method.
Collapse
|
|
32
|
Kaise M, Kato M, Tajiri H. High-definition endoscopy and magnifying endoscopy combined with narrow band imaging in gastric cancer. Gastroenterol Clin North Am 2010; 39:771-84. [PMID: 21093754 DOI: 10.1016/j.gtc.2010.08.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastric cancer is the third common cancer and is the second leading cause of cancer deaths worldwide. Endoscopy is being increasingly used for gastric cancer screening because of a high detection rate. Despite promising data, the technique depends heavily on the availability of endoscopic instruments and expertise for mass screening. Furthermore, the introduction of various new endoscopic devices and techniques may enhance the value of endoscopy in efficacious cancer screening. High-definition endoscopy and image-enhanced endoscopy, including narrow band imaging, are the key modalities in advanced endoscopic imaging in gastric cancer.
Collapse
Affiliation(s)
- Mitsuru Kaise
- Department of Gastroenterology, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo 105-8470, Japan.
| | | | | |
Collapse
|
|
33
|
Shao X, Zheng W, Huang Z. Polarized near-infrared autofluorescence imaging combined with near-infrared diffuse reflectance imaging for improving colonic cancer detection. OPTICS EXPRESS 2010; 18:24293-300. [PMID: 21164775 DOI: 10.1364/oe.18.024293] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
We evaluate the diagnostic feasibility of the integrated polarized near-infrared (NIR) autofluorescence (AF) and NIR diffuse reflectance (DR) imaging technique developed for colonic cancer detection. A total of 48 paired colonic tissue specimens (normal vs. cancer) were measured using the integrated NIR DR (850-1100 nm) and NIR AF imaging at the 785 nm laser excitation. The results showed that NIR AF intensities of cancer tissues are significantly lower than those of normal tissues (p<0.001, paired 2-sided Student's t-test, n=48). NIR AF imaging under polarization conditions gives a higher diagnostic accuracy (of ~92-94%) compared to non-polarized NIR AF imaging or NIR DR imaging. Further, the ratio imaging of NIR DR to NIR AF with polarization provides the best diagnostic accuracy (of ~96%) among the NIR AF and NIR DR imaging techniques. This work suggests that the integrated NIR AF/DR imaging under polarization condition has the potential to improve the early diagnosis and detection of malignant lesions in the colon.
Collapse
Affiliation(s)
- Xiaozhuo Shao
- Optical Bioimaging Laboratory, Department of Bioengineering, Faculty of Engineering, National University of Singapore, 117576 Singapore
| | | | | |
Collapse
|
|
34
|
Rex DK. Update on colonoscopic imaging and projections for the future. Clin Gastroenterol Hepatol 2010; 8:318-21. [PMID: 20026427 DOI: 10.1016/j.cgh.2009.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 12/06/2009] [Indexed: 02/07/2023]
|
|
35
|
Rex DK, Fennerty MB, Sharma P, Kaltenbach T, Soetikno R. Bringing new endoscopic imaging technology into everyday practice: what is the role of professional GI societies? Polyp imaging as a template for moving endoscopic innovation forward to answer key clinical questions. Gastrointest Endosc 2010; 71:142-6. [PMID: 19922926 DOI: 10.1016/j.gie.2009.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 09/13/2009] [Indexed: 02/08/2023]
|