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Wan W, Liu H, Zou J, Xie T, Zhang G, Ying W, Zou X. The optimization and application of photodynamic diagnosis and autofluorescence imaging in tumor diagnosis and guided surgery: current status and future prospects. Front Oncol 2025; 14:1503404. [PMID: 39845324 PMCID: PMC11750647 DOI: 10.3389/fonc.2024.1503404] [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: 09/28/2024] [Accepted: 12/19/2024] [Indexed: 01/24/2025] Open
Abstract
Photodynamic diagnosis (PDD) and autofluorescence imaging (AFI) are emerging cancer diagnostic technologies that offer significant advantages over traditional white-light endoscopy in detecting precancerous lesions and early-stage cancers; moreover, they hold promising potential in fluorescence-guided surgery (FGS) for tumors. However, their shortcomings have somewhat hindered the clinical application of PDD and AFI. Therefore, it is imperative to enhance the efficacy of PDD and AFI, thereby maximizing their potential for practical clinical use. This article reviews the principles, characteristics, current research status, and advancements of PDD and AFI, focusing on analyzing and discussing the optimization strategies of PDD and AFI in tumor diagnosis and FGS scenarios. Considering the practical and technical feasibility, optimizing PDD and AFI may result in an effective real-time diagnostic tool to guide clinicians in tumor diagnosis and surgical guidance to achieve the best results.
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Affiliation(s)
- Wei Wan
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huiquan Liu
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Junrong Zou
- Institute of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Tianpeng Xie
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Guoxi Zhang
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Weihai Ying
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaofeng Zou
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
- Institute of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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Browning CM, Cloutier R, Rich TC, Leavesley SJ. Endoscopy Lifetime Systems Architecture: Scoping Out the Past to Diagnose the Future Technology. SYSTEMS 2022; 10:189. [PMID: 36330206 PMCID: PMC9627979 DOI: 10.3390/systems10050189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Systems engineering captures the desires and needs of the customer to conceptualize a system from the overall goal down to the small details prior to any physical development. While many systems projects tend to be large and complicated (i.e., cloud-based infrastructure, long-term space travel shuttles, missile defense systems), systems engineering can also be applied to smaller, complex systems. Here, the system of interest is the endoscope, a standard biomedical screening device used in laparoscopic surgery, screening of upper and lower gastrointestinal tracts, and inspection of the upper airway. Often, endoscopic inspection is used to identify pre-cancerous and cancerous tissues, and hence, a requirement for endoscopic systems is the ability to provide images with high contrast between areas of normal tissue and neoplasia (early-stage abnormal tissue growth). For this manuscript, the endoscope was reviewed for all the technological advancements thus far to theorize what the next version of the system could be in order to provide improved detection capabilities. Endoscopic technology was decomposed into categories, using systems architecture and systems thinking, to visualize the improvements throughout the system's lifetime from the original to current state-of-the-art. Results from this review were used to identify trends in subsystems and components to estimate the theoretical performance maxima for different subsystems as well as areas for further development. The subsystem analysis indicated that future endoscope systems will focus on more complex imaging and higher computational requirements that will provide improved contrast in order to have higher accuracy in optical diagnoses of early, abnormal tissue growth.
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Affiliation(s)
- Craig M. Browning
- Department of Chemical and Biomolecular Engineering, University of South Alabama, Mobile, AL 36688, USA
- Department of Systems Engineering, University of South Alabama, Mobile, AL 36688, USA
| | - Robert Cloutier
- Department of Systems Engineering, University of South Alabama, Mobile, AL 36688, USA
| | - Thomas C. Rich
- Department of Pharmacology, University of South Alabama, Mobile, AL 36688, USA
- Center for Lung Biology, University of South Alabama, Mobile, AL 36688, USA
| | - Silas J. Leavesley
- Department of Chemical and Biomolecular Engineering, University of South Alabama, Mobile, AL 36688, USA
- Department of Pharmacology, University of South Alabama, Mobile, AL 36688, USA
- Center for Lung Biology, University of South Alabama, Mobile, AL 36688, USA
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Abstract
This article explores advances in endoscopic neoplasia detection with supporting clinical evidence and future aims. The ability to detect early gastric neoplastic lesions amenable to curative endoscopic submucosal dissection provides the opportunity to decrease gastric cancer mortality rates. Newer imaging techniques offer enhanced views of mucosal and microvascular structures and show promise in differentiating benign from malignant lesions and improving targeted biopsies. Conventional chromoendoscopy is well studied and validated. Narrow band imaging demonstrates superiority over magnified white light. Autofluorescence imaging, i-scan, flexible spectral imaging color enhancement, and bright image enhanced endoscopy show promise but insufficient evidence to change current clinical practice.
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Affiliation(s)
- Andrew Canakis
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, USA. https://twitter.com/AndrewCanakis
| | - Raymond Kim
- Division of Gastroenterology & Hepatology, University of Maryland Medical Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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He Z, Wang P, Liang Y, Fu Z, Ye X. Clinically Available Optical Imaging Technologies in Endoscopic Lesion Detection: Current Status and Future Perspective. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:7594513. [PMID: 33628407 PMCID: PMC7886528 DOI: 10.1155/2021/7594513] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 01/02/2023]
Abstract
Endoscopic optical imaging technologies for the detection and evaluation of dysplasia and early cancer have made great strides in recent decades. With the capacity of in vivo early detection of subtle lesions, they allow modern endoscopists to provide accurate and effective optical diagnosis in real time. This review mainly analyzes the current status of clinically available endoscopic optical imaging techniques, with emphasis on the latest updates of existing techniques. We summarize current coverage of these technologies in major hospital departments such as gastroenterology, urology, gynecology, otolaryngology, pneumology, and laparoscopic surgery. In order to promote a broader understanding, we further cover the underlying principles of these technologies and analyze their performance. Moreover, we provide a brief overview of future perspectives in related technologies, such as computer-assisted diagnosis (CAD) algorithms dealing with exploring endoscopic video data. We believe all these efforts will benefit the healthcare of the community, help endoscopists improve the accuracy of diagnosis, and relieve patients' suffering.
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Affiliation(s)
- Zhongyu He
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Peng Wang
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Yuelong Liang
- Department of General Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Zuoming Fu
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Xuesong Ye
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
- State Key Laboratory of CAD and CG, Zhejiang University, Hangzhou 310058, China
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Fu Z, Jin Z, Zhang C, He Z, Zha Z, Hu C, Gan T, Yan Q, Wang P, Ye X. The Future of Endoscopic Navigation: A Review of Advanced Endoscopic Vision Technology. IEEE ACCESS 2021; 9:41144-41167. [DOI: 10.1109/access.2021.3065104] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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6
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Suprano A, Giordani T, Gianani I, Spagnolo N, Pinker K, Kupferman J, Arnon S, Klemm U, Gorpas D, Ntziachristos V, Sciarrino F. Propagation of structured light through tissue-mimicking phantoms. OPTICS EXPRESS 2020; 28:35427-35437. [PMID: 33379657 DOI: 10.1364/oe.402467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/03/2020] [Indexed: 06/12/2023]
Abstract
Optical interrogation of tissues is broadly considered in biomedical applications. Nevertheless, light scattering by tissue limits the resolution and accuracy achieved when investigating sub-surface tissue features. Light carrying optical angular momentum or complex polarization profiles, offers different propagation characteristics through scattering media compared to light with unstructured beam profiles. Here we discuss the behaviour of structured light scattered by tissue-mimicking phantoms. We study the spatial and the polarization profile of the scattered modes as a function of a range of optical parameters of the phantoms, with varying scattering and absorption coefficients and of different lengths. These results show the non-trivial trade-off between the advantages of structured light profiles and mode broadening, stimulating further investigations in this direction.
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7
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Li H, Hou X, Lin R, Fan M, Pang S, Jiang L, Liu Q, Fu L. Advanced endoscopic methods in gastrointestinal diseases: a systematic review. Quant Imaging Med Surg 2019; 9:905-920. [PMID: 31281783 PMCID: PMC6571190 DOI: 10.21037/qims.2019.05.16] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/10/2019] [Indexed: 12/15/2022]
Abstract
Endoscopic imaging is the main method for detecting gastrointestinal diseases, which adversely affect human health. White light endoscopy (WLE) was the first method used for endoscopic examination and is still the preliminary step in the detection of gastrointestinal diseases during clinical examination. However, it cannot accurately diagnose gastrointestinal diseases owing to its poor correlation with histopathological diagnosis. In recent years, many advanced endoscopic methods have emerged to improve the detection accuracy by endoscopy. Chromoendoscopy (CE) enhances the contrast between normal and diseased tissues using biocompatible dye agents. Narrow band imaging (NBI) can improve the contrast between capillaries and submucosal vessels by changing the light source acting on the tissue using special filters to realize the visualization of the vascular structure. Flexible spectral imaging color enhancement (FICE) technique uses the reflectance spectrum estimation technique to obtain individual spectral images and reconstructs an enhanced image of the mucosal surface using three selected spectral images. The i-Scan technology takes advantage of the different reflective properties of normal and diseased tissues to obtain images, and enhances image contrast through post-processing algorithms. These abovementioned methods can be used to detect gastrointestinal diseases by observing the macroscopic structure of the digestive tract mucosa, but the ability of early cancer detection is limited with low resolution. However, based on the principle of confocal imaging, probe-based confocal laser endomicroscopy (pCLE) can enable cellular visualization with high-performance probes, which can present cellular morphology that is highly consistent with that shown by biopsy to provide the possibility of early detection of cancer. Other endoscopic imaging techniques including endoscopic optical coherence tomography (EOCT) and photoacoustic endoscopy (PAE), are also promising for diagnosing gastrointestinal diseases. This review focuses on these technologies and aims to provide an overview of different technologies and their clinical applicability.
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Affiliation(s)
- Hua Li
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan 430074, China
- MoE Key Laboratory for Biomedical Photonics, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Xiaohua Hou
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Rong Lin
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Mengke Fan
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Suya Pang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Longjie Jiang
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan 430074, China
- MoE Key Laboratory for Biomedical Photonics, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Qian Liu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan 430074, China
- MoE Key Laboratory for Biomedical Photonics, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Ling Fu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan 430074, China
- MoE Key Laboratory for Biomedical Photonics, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
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8
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Amadi C, Gatenby P. Barrett’s oesophagus: Current controversies. World J Gastroenterol 2017; 23:5051-5067. [PMID: 28811703 PMCID: PMC5537175 DOI: 10.3748/wjg.v23.i28.5051] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/03/2017] [Accepted: 07/04/2017] [Indexed: 02/06/2023] Open
Abstract
Oesophageal adenocarcinoma is rapidly increasing in Western countries. This tumour frequently presents late in its course with metastatic disease and has a very poor prognosis. Barrett’s oesophagus is an acquired condition whereby the native squamous mucosa of the lower oesophagus is replaced by columnar epithelium following prolonged gastro-oesophageal reflux and is the recognised precursor lesion for oesophageal adenocarcinoma. There are multiple national and society guidelines regarding screening, surveillance and management of Barrett’s oesophagus, however all are limited regarding a clear evidence base for a well-demonstrated benefit and cost-effectiveness of surveillance, and robust risk stratification for patients to best use resources. Currently the accepted risk factors upon which surveillance intervals and interventions are based are Barrett’s segment length and histological interpretation of the systematic biopsies. Further patient risk factors including other demographic features, smoking, gender, obesity, ethnicity, patient age, biomarkers and endoscopic adjuncts remain under consideration and are discussed in full. Recent evidence has been published to support earlier endoscopic intervention by means of ablation of the metaplastic Barrett’s segment when the earliest signs of dysplasia are detected. Further work should concentrate on establishing better risk stratification and primary and secondary preventative strategies to reduce the risk of adenocarcinoma of the oesophagus.
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9
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Leavesley SJ, Walters M, Lopez C, Baker T, Favreau PF, Rich TC, Rider PF, Boudreaux CW. Hyperspectral imaging fluorescence excitation scanning for colon cancer detection. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:104003. [PMID: 27792808 PMCID: PMC5084534 DOI: 10.1117/1.jbo.21.10.104003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/04/2016] [Indexed: 05/06/2023]
Abstract
Optical spectroscopy and hyperspectral imaging have shown the potential to discriminate between cancerous and noncancerous tissue with high sensitivity and specificity. However, to date, these techniques have not been effectively translated to real-time endoscope platforms. Hyperspectral imaging of the fluorescence excitation spectrum represents new technology that may be well suited for endoscopic implementation. However, the feasibility of detecting differences between normal and cancerous mucosa using fluorescence excitation-scanning hyperspectral imaging has not been evaluated. The goal of this study was to evaluate the initial feasibility of using fluorescence excitation-scanning hyperspectral imaging for measuring changes in fluorescence excitation spectrum concurrent with colonic adenocarcinoma using a small pre-pilot-scale sample size. Ex vivo analysis was performed using resected pairs of colorectal adenocarcinoma and normal mucosa. Adenocarcinoma was confirmed by histologic evaluation of hematoxylin and eosin (H&E) permanent sections. Specimens were imaged using a custom hyperspectral imaging fluorescence excitation-scanning microscope system. Results demonstrated consistent spectral differences between normal and cancerous tissues over the fluorescence excitation range of 390 to 450 nm that could be the basis for wavelength-dependent detection of colorectal cancers. Hence, excitation-scanning hyperspectral imaging may offer an alternative approach for discriminating adenocarcinoma from surrounding normal colonic mucosa, but further studies will be required to evaluate the accuracy of this approach using a larger patient cohort.
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Affiliation(s)
- Silas J. Leavesley
- University of South Alabama, Department of Chemical and Biomolecular Engineering, 150 Jaguar Drive, SH 4129, Mobile, Alabama 36688, United States
- University of South Alabama, Department of Pharmacology, 5851 USA North Drive, MSB 3372, Mobile, Alabama 36688, United States
- University of South Alabama, Center for Lung Biology, 5851 USA North Drive, MSB 3340, Mobile, Alabama 36688, United States
| | - Mikayla Walters
- University of South Alabama, Department of Chemical and Biomolecular Engineering, 150 Jaguar Drive, SH 4129, Mobile, Alabama 36688, United States
| | - Carmen Lopez
- University of South Alabama, Medical Sciences Program, 5851 USA North Drive, MSB 3340, Mobile, Alabama 36688, United States
| | - Thomas Baker
- University of South Alabama, Department of Pharmacology, 5851 USA North Drive, MSB 3372, Mobile, Alabama 36688, United States
| | - Peter F. Favreau
- University of South Alabama, Department of Chemical and Biomolecular Engineering, 150 Jaguar Drive, SH 4129, Mobile, Alabama 36688, United States
- University of South Alabama, Center for Lung Biology, 5851 USA North Drive, MSB 3340, Mobile, Alabama 36688, United States
| | - Thomas C. Rich
- University of South Alabama, Department of Pharmacology, 5851 USA North Drive, MSB 3372, Mobile, Alabama 36688, United States
- University of South Alabama, Center for Lung Biology, 5851 USA North Drive, MSB 3340, Mobile, Alabama 36688, United States
| | - Paul F. Rider
- University of South Alabama, Department of Surgery, 2451 Fillingim Street, Mastin Building, Suite 701, Mobile, Alabama 36617, United States
| | - Carole W. Boudreaux
- University of South Alabama, Department of Pathology, 2451 Fillingim Street, Mobile, Alabama 36617, United States
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10
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Liu ML, Qu YW, Liu HF. Application of endoscopic molecular imaging in diagnosis of gastric intestinal metaplasia. Shijie Huaren Xiaohua Zazhi 2016; 24:203-208. [DOI: 10.11569/wcjd.v24.i2.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastric intestinal metaplasia (GIM) is a precancerous lesion of intestinal type gastric carcinoma. Early diagnosis and follow-up can improve the detection rate of early gastric cancer. In recent years, with the integration of molecular imaging into endoscopy, auto fluorescence endoscopy, Raman spectroscopy, two-photon fluorescence endomicroscopy, and confocal laser endomicroscopy have emerged, which improves the detection rate of GIM. This paper reviews the progress of the application of endoscopic molecular imaging in the diagnosis of GIM.
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Abstract
Although removal of adenomatous polyps has been shown to decrease the risk of colon cancer, distal hyperplastic polyps are thought to not have malignant potential. Most polyps detected during colonoscopy are diminutive (≤ 5 mm) and rarely harbor advanced histology, such as high-grade dysplasia or cancer. Therefore, predicting histology in real-time during colonoscopy can potentially decrease the enormous expenditure that ensues from universal histopathologic evaluation of polyps, and several novel imaging technologies have been developed and tested over the past decade for this purpose. Of these different technologies, electronic chromoendoscopy seems to strike a fair balance between accuracy, feasibility, and cost.
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Affiliation(s)
- Shreyas Saligram
- University of Kansas School of Medicine, University of Kansas, Department of Gastroenterology, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Veterans Affairs Medical Center, Department of Gastroenterology, 4801 Linwood Blvd, Kansas City, MO 64128, USA
| | - Amit Rastogi
- University of Kansas School of Medicine, University of Kansas, Department of Gastroenterology, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Veterans Affairs Medical Center, Department of Gastroenterology, 4801 Linwood Blvd, Kansas City, MO 64128, USA.
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12
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Lee ES, Kim TS, Kim SK. Current status of optical imaging for evaluating lymph nodes and lymphatic system. Korean J Radiol 2015; 16:21-31. [PMID: 25598672 PMCID: PMC4296273 DOI: 10.3348/kjr.2015.16.1.21] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 07/30/2014] [Indexed: 12/26/2022] Open
Abstract
Optical imaging techniques use visual and near infrared rays. Despite their considerably poor penetration depth, they are widely used due to their safe and intuitive properties and potential for intraoperative usage. Optical imaging techniques have been actively investigated for clinical imaging of lymph nodes and lymphatic system. This article summarizes a variety of optical tracers and techniques used for lymph node and lymphatic imaging, and reviews their clinical applications. Emerging new optical imaging techniques and their potential are also described.
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Affiliation(s)
- Eun Seong Lee
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea
| | - Tae Sung Kim
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea
| | - Seok-Ki Kim
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea
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Ramzan Z, Nassri AB, Huerta S. The use of imaging and biomarkers in diagnosing Barrett's esophagus and predicting the risk of neoplastic progression. Expert Rev Mol Diagn 2014; 14:575-91. [PMID: 24831686 DOI: 10.1586/14737159.2014.919856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Long-standing gastroesophageal reflux disease can result in transformation of the normal squamous lining of the esophagus into columnar epithelium (with goblet cells). This condition, Barrett's esophagus (BE), is considered a risk factor for esophageal cancer (EAC) and may be the cause of the increased incidence of EAC over the last few decades. Currently, endoscopy with biopsies revealing dysplasia is the best predictor for neoplastic progression in patients with BE. However, the use of more sophisticated imaging techniques and biomarkers with or without histological assessment may be helpful in more accurate prediction of malignant transformation in these patients. New approaches to the evaluation of BE such as epigenetics, miRNA analysis, detection of DNA content abnormalities and loss of heterozygosity have great potential to shed light on the complex gastroesophageal reflux disease -BE-EAC sequence.
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Affiliation(s)
- Zeeshan Ramzan
- VA North Texas Healthcare System - Dallas VA Medical Center, University of Texas Southwestern Medical Center, 4500 S. Lancaster Road, Dallas, TX 75216, USA
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Coda S, Thillainayagam AV. State of the art in advanced endoscopic imaging for the detection and evaluation of dysplasia and early cancer of the gastrointestinal tract. Clin Exp Gastroenterol 2014; 7:133-50. [PMID: 24868168 PMCID: PMC4028486 DOI: 10.2147/ceg.s58157] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Ideally, endoscopists should be able to detect, characterize, and confirm the nature of a lesion at the bedside, minimizing uncertainties and targeting biopsies and resections only where necessary. However, under conventional white-light inspection – at present, the sole established technique available to most of humanity – premalignant conditions and early cancers can frequently escape detection. In recent years, a range of innovative techniques have entered the endoscopic arena due to their ability to enhance the contrast of diseased tissue regions beyond what is inherently possible with standard white-light endoscopy equipment. The aim of this review is to provide an overview of the state-of-the-art advanced endoscopic imaging techniques available for clinical use that are impacting the way precancerous and neoplastic lesions of the gastrointestinal tract are currently detected and characterized at endoscopy. The basic instrumentation and the physics behind each method, followed by the most influential clinical experience, are described. High-definition endoscopy, with or without optical magnification, has contributed to higher detection rates compared with white-light endoscopy alone and has now replaced ordinary equipment in daily practice. Contrast-enhancement techniques, whether dye-based or computed, have been combined with white-light endoscopy to further improve its accuracy, but histology is still required to clarify the diagnosis. Optical microscopy techniques such as confocal laser endomicroscopy and endocytoscopy enable in vivo histology during endoscopy; however, although of invaluable assistance for tissue characterization, they have not yet made transition between research and clinical use. It is still unknown which approach or combination of techniques offers the best potential. The optimal method will entail the ability to survey wide areas of tissue in concert with the ability to obtain the degree of detailed information provided by microscopic techniques. In this respect, the challenging combination of autofluorescence imaging and confocal endomicroscopy seems promising, and further research is awaited.
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Affiliation(s)
- Sergio Coda
- Section of Gastroenterology and Hepatology, Department of Medicine and Photonics Group, Department of Physics, Imperial College London, London, UK ; Endoscopy Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew V Thillainayagam
- Section of Gastroenterology and Hepatology, Department of Medicine and Photonics Group, Department of Physics, Imperial College London, London, UK ; Endoscopy Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Rees CJ, Rajasekhar PT, Rutter MD, Dekker E. Quality in colonoscopy: European perspectives and practice. Expert Rev Gastroenterol Hepatol 2014; 8:29-47. [PMID: 24410471 DOI: 10.1586/17474124.2014.858599] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Colonoscopy is the 'gold standard' investigation of the colon. High quality colonoscopy is essential to diagnose early cancer and reduce its incidence through the detection and removal of pre-malignant adenomas. In this review, we discuss the key components of a high quality colonoscopy, review methods for improving quality, emerging technologies that have the potential to improve quality and highlight areas for future work.
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Affiliation(s)
- Colin J Rees
- South Tyneside District Hospital, Harton Lane, South Shields, Tyne and Wear, NE34 0PL, UK
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16
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Bergholt MS, Zheng W, Ho KY, Teh M, Yeoh KG, So JBY, Shabbir A, Huang Z. Fiber-optic Raman spectroscopy probes gastric carcinogenesis in vivo at endoscopy. JOURNAL OF BIOPHOTONICS 2013; 6:49-59. [PMID: 23288709 DOI: 10.1002/jbio.201200138] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 10/07/2012] [Accepted: 11/07/2012] [Indexed: 05/19/2023]
Abstract
Intestinal-type gastric carcinogenesis is a complex multi-step disease, and early precursors (e.g. intestinal metaplasia (IM), dysplasia) can be very challenging to identify using conventional white-light endoscopic imaging. This study aims to assess the capability of Raman spectroscopy for multi-class elucidation of intestinal-type gastric carcinogenesis sequence in vivo for improving precancer detection at endoscopy. We employ a novel image-guided Raman endoscopy technique developed for in vivo gastric tissue Raman measurement within 0.5 s during clinical endoscopic examination. We have acquired a total of 1277 in vivo Raman spectra from 83 gastric patients associated with intestinal-type carcinogenesis. In vivo Raman spectroscopy integrated with semi-quantitative spectral modelling (e.g. DNA, lipids, glycoprotein, proteins and blood) reveals the progressive changes of biochemical constituents in gastric tissue associated with preneoplastic and neoplastic transformation (i.e., IM, dysplasia and adenocarcinoma). Multi-class probabilistic partial least squares-discriminant analysis (PLS-DA) diagnostic algorithms based on in vivo Raman spectra are able to identify normal mucosa with sensitivity of 75.88% and specificity of 87.21%; IM with sensitivity of 46.67% and specificity of 87.55%; dysplasia with sensitivity of 83.33%; specificity of 95.80%, and adenocarcinoma with sensitivity of 84.91% and specificity 95.57%, respectively. This work demonstrates that Raman spectroscopy is a sensitive biomolecular probe for monitoring intestinal-type gastric carcinogenesis to realize early diagnosis and detection of precancer and early gastric cancer in vivo during clinical endoscopic examination.
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Affiliation(s)
- Mads Sylvest Bergholt
- Department of Bioengineering, Faculty of Engineering, National University of Singapore, Singapore
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Rotondano G, Bianco MA, Sansone S, Prisco A, Meucci C, Garofano ML, Cipolletta L. Trimodal endoscopic imaging for the detection and differentiation of colorectal adenomas: a prospective single-centre clinical evaluation. Int J Colorectal Dis 2012; 27:331-6. [PMID: 21904833 DOI: 10.1007/s00384-011-1312-7] [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
PURPOSE The purpose of this study is to evaluate an endoscopic trimodal imaging (ETMI) system (high resolution, autofluorescence, and NBI) in the detection and differentiation of colorectal adenomas. METHODS A prospective randomised trial of tandem colonoscopies was carried out using the Olympus XCF-FH260AZI system. Each colonic segment was examined twice for lesions, once with HRE and once with AFI, in random order per patient. All detected lesions were assessed with NBI for pit pattern and with AFI for colour. All lesions were removed and sent for histology. Any lesion identified on the second examination was considered as missed by the first examination. Outcome measures are adenoma miss rates of AFI and HRE, and diagnostic accuracy of NBI and AFI for differentiating neoplastic from non-neoplastic lesions. RESULTS Ninety-four patients underwent colonoscopy with ETMI (47 in each group). Among 47 patients examined with AFI first, 31 adenomas in 15 patients were detected initially [detection rate 0.66 (0.52-0.75)]. Subsequent HRE inspection identified six additional adenomas. Among 47 patients examined with HRE first, 29 adenomas in 14 patients were detected initially [detection rate 0.62 (0.53-0.79)]. Successive AFI yielded seven additional adenomas. Adenoma miss rates of AFI and HRE were 14% and 16.2%, respectively (p = 0.29). Accuracy of AFI alone for differentiation was lower than NBI (63% vs. 80%, p < 0.001). Combined use of AFI and NBI achieved improved accuracy for differentiation (84%), showing a trend for superiority compared with NBI alone (p = 0.064). CONCLUSIONS AFI did not significantly reduce the adenoma miss rate compared with HRE. AFI alone had a disappointing accuracy for adenoma differentiation, which could be improved by combination of AFI and NBI.
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Affiliation(s)
- Gianluca Rotondano
- Division of Gastroenterology, ASL NA3sud-Ospedale Maresca, Torre del Greco, Italy.
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18
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Shukla R, Abidi WM, Richards-Kortum R, Anandasabapathy S. Endoscopic imaging: How far are we from real-time histology? World J Gastrointest Endosc 2011; 3:183-94. [PMID: 22013499 PMCID: PMC3196726 DOI: 10.4253/wjge.v3.i10.183] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 07/15/2011] [Accepted: 08/30/2011] [Indexed: 02/05/2023] Open
Abstract
Currently, in gastrointestinal endoscopy there is increasing interest in high resolution endoscopic technologies that can complement high-definition white light endoscopy by providing real-time subcellular imaging of the epithelial surface. These ‘optical biopsy’ technologies offer the potential to improve diagnostic accuracy and yield, while facilitating real-time decision-making. Although many endoscopic techniques have preliminarily shown high accuracy rates, these technologies are still evolving. This review will provide an overview of the most promising high-resolution imaging technologies, including high resolution microendoscopy, optical coherence tomography, endocytoscopy and confocal laser endoscopy. This review will also discuss the application and current limitations of these technologies for the early detection of neoplasia in Barrett’s esophagus, ulcerative colitis and colorectal cancer.
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Affiliation(s)
- Richa Shukla
- Richa Shukla, Wasif M Abidi, Sharmila Anandasabapathy, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, United States
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Banerjee R, Reddy DN. Enhanced endoscopic imaging and gastroesophageal reflux disease. Indian J Gastroenterol 2011; 30:193-200. [PMID: 22009671 DOI: 10.1007/s12664-011-0137-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 09/24/2011] [Indexed: 02/07/2023]
Abstract
Gastroesophageal reflux disease (GERD) and GERD-related symptoms are common, and affect 25% to 30% of the general population. Upper gastrointestinal endoscopy of the esophagus has been the most widely used modality for the diagnosis and grading of reflux disease. Endoscopic imaging today has evolved beyond the confines of routine white light endoscopy (WLE) to advanced optical imaging with a precise and real time endoscopic diagnosis. These technological advances have helped circumvent the limitation of WLE in reflux disease by a) improved detection of subtle irregularities, b) characterization of anomalies, and c) possible optical biopsies providing real-time diagnosis. This review attempts to define the current status of these newer technologies vis-a-vis the diagnosis and management of gastroesophageal reflux disease.
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Affiliation(s)
- Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082 Andhra Pradesh, India
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20
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Wang RCC, Deen MJ, Armstrong D, Fang Q. Development of a catadioptric endoscope objective with forward and side views. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:066015. [PMID: 21721816 DOI: 10.1117/1.3593148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Autofluorescence endoscopy is a promising functional imaging technique to improve screening of pre-cancerous or early cancer lesions in the gastrointestinal (GI) tract. Tissue autofluorescence signal is weak compared to white light reflectance imaging. Conventional forward-viewing endoscopes are inefficient in the collection of light from objects of interest along on the GI luminal wall. A key component of a complete autofluorescence endoscope is the light collection module. In this paper, we report the design, optimization, prototype development, and testing of an endoscope objective that is capable of acquiring simultaneous forward and radial views. The radial-view optical design was optimized for a balance between image quality and light collection. Modulation transfer function (MTF), entrance pupil radius, manufacturability, and field-of-view were parameters used in the lens optimization. In comparison with the typical forward-viewing endoscopes, our nonsequential ray trace simulations suggest the proposed radial-view design is more practical in the light collection. To validate the proposed simulation methods, a 3:1 scaled-up prototype was fabricated. Contrast measurements were taken with the prototype, and then compared with the simulated MTF.
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Affiliation(s)
- Roy Chih Chung Wang
- McMaster University, Department of Engineering Physics, 1280 Main Street West, Hamilton, Ontario, L8S 4L7, Canada
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21
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Bergholt MS, Zheng W, Lin K, Ho KY, Teh M, Yeoh KG, So JBY, Huang Z. Combining near-infrared-excited autofluorescence and Raman spectroscopy improves in vivo diagnosis of gastric cancer. Biosens Bioelectron 2011; 26:4104-10. [PMID: 21550225 DOI: 10.1016/j.bios.2011.04.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/30/2011] [Accepted: 04/05/2011] [Indexed: 12/20/2022]
Abstract
This study aims to evaluate the diagnostic utility of the combined near-infrared (NIR) autofluorescence (AF) and Raman spectroscopy for improving in vivo detection of gastric cancer at clinical gastroscopy. A rapid Raman endoscopic technique was employed for in vivo spectroscopic measurements of normal (n=1098) and cancer (n=140) gastric tissues from 81 gastric patients. The composite NIR AF and Raman spectra in the range of 800-1800 cm(-1) were analyzed using principal component analysis (PCA) and linear discriminant (LDA) to extract diagnostic information associated with distinctive spectroscopic processes of gastric malignancies. High quality in vivo composite NIR AF and Raman spectra can routinely be acquired from the gastric within 0.5s. The integrated intensity over the range of 800-1800 cm(-1) established the diagnostic implications (p=1.6E-14) of the change of NIR AF intensity associated with neoplastic transformation. PCA-LDA diagnostic modeling on the in vivo tissue NIR AF and Raman spectra acquired yielded a diagnostic accuracy of 92.2% (sensitivity of 97.9% and specificity of 91.5%) for identifying gastric cancer from normal tissue. The integration area under the receiver operating characteristic (ROC) curve using the combined NIR AF and Raman spectroscopy was 0.985, which is superior to either the Raman spectroscopy or NIR AF spectroscopy alone. This work demonstrates that the complementary Raman and NIR AF spectroscopy techniques can be integrated together for improving the in vivo diagnosis and detection of gastric cancer at endoscopy.
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Affiliation(s)
- Mads Sylvest Bergholt
- Optical Bioimaging Laboratory, Department of Bioengineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576, Singapore
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22
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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]
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Paderni C, Compilato D, Carinci F, Nardi G, Rodolico V, Lo Muzio L, Spinelli G, Mazzotta M, Campisi G. Direct visualization of oral-cavity tissue fluorescence as novel aid for early oral cancer diagnosis and potentially malignant disorders monitoring. Int J Immunopathol Pharmacol 2011; 24:121-128. [PMID: 21781457 DOI: 10.1177/03946320110240s221] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
Direct visualization of the oral tissue autofluorescence has been recently reviewed in several studies as a possible adjunctive tool for early recognition and diagnosis of potentially malignant and malignant oral disorders. The aims of this study were to assess: a) the value of a simple handheld device for tissue auto-fluorescence visualization of potentially malignant oral lesions; and b) the sensitivity, specificity and diagnostic accuracy of tested device, using histological examination as the gold standard. 175 consecutive patients, with at least one clinical oral lesion, were enrolled in the study. Clinical conventional inspections were performed for each patient by two blind operators. Then, oral biopsy and histological examination were performed. Pathologist was blind with respect to the autofluorescence results. The 175 histological assessments revealed no dysplasia, mild dysplasia, moderate/severe dysplasia and OSCC, in the 67.4%, 8.6%, 8%, 16% of cases, respectively. Oral lesions diagnosed as OSCC were found as positive under fluorescent light in the 96.4% of cases. Statistically significant correlation was observed between oral dysplastic lesions and the loss of tissue fluorescence (p-value=0.001). Low sensitivity values (60% and 71%) were recorded about the ability of the device in differentiating mild dysplasia vs. lack of dysplasia and moderate/severe dysplasia vs absence of dysplasia, respectively. The device tested in our study was found to not replace the histopathology procedure. However, we assessed its usefulness for oral tissue examination, especially within an oral medicine secondary care facility, before performing a biopsy and in monitoring oral lesions.
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Affiliation(s)
- C Paderni
- Department of Oral Sciences, Sector of Oral Medicine V. Margiotta, University of Palermo, Palermo, Italy
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24
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[Endoscopic technique in endobrachyoesophagus diagnosis: Chromoendoscopy and acetic acid]. Presse Med 2011; 40:502-7. [PMID: 21440407 DOI: 10.1016/j.lpm.2011.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 02/07/2011] [Indexed: 11/22/2022] Open
Abstract
Screening for complications of neoplastic Barrett's oesophagus requires a tedious blind standardized protocol biopsies quadrant every 1 to 2cm depending on the morphology of the Barrett's epithelium (Protocol of Seattle). To achieve that biopsies targeted to areas suspicious of dysplasia, a method of high sensitivity is required. Chromoendoscopy has been developed in this direction. Acetic acid combined with high resolution endoscopy and zooming represents an aid in the preparation of the oesophageal mucosa for visualization of suspicious anomalies. It is safe, cheap and easy to use. Acetic acid has proven its value in improving the visibility of the pit pattern. Several vital dyes have been tested, including methylene blue, indigo carmine and crystal violet, with mixed results. The FICE(®) and NBI(®), immediate, reversible and attractive virtual chromoendoscopy techniques represent interesting tools for improving sensitivity in screening for Barrett's oesophagus and its complications. Confocal endomicroscopy, which is similar as a "per-endoscopic real time histological examination", seems to be equally a promising technique in detection of Barrett's oesophagus associated neoplasia. But these tools which are capable of improvement so far, have not proved their use on a large population. For this, the systematic biopsy protocol Seattle remains the "gold standard" in monitoring the Barrett's oesophagus.
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25
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Solomon M, Liu Y, Berezin MY, Achilefu S. Optical imaging in cancer research: basic principles, tumor detection, and therapeutic monitoring. Med Princ Pract 2011; 20:397-415. [PMID: 21757928 PMCID: PMC7388590 DOI: 10.1159/000327655] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 03/16/2011] [Indexed: 01/19/2023] Open
Abstract
Accurate and rapid detection of diseases is of great importance for assessing the molecular basis of pathogenesis, preventing the onset of complications, and implementing a tailored therapeutic regimen. The ability of optical imaging to transcend wide spatial imaging scales ranging from cells to organ systems has rejuvenated interest in using this technology for medical imaging. Moreover, optical imaging has at its disposal diverse contrast mechanisms for distinguishing normal from pathologic processes and tissues. To accommodate these signaling strategies, an array of imaging techniques has been developed. Importantly, light absorption, and emission methods, as well as hybrid optical imaging approaches are amenable to both small animal and human studies. Typically, complex methods are needed to extract quantitative data from deep tissues. This review focuses on the development of optical imaging platforms, image processing techniques, and molecular probes, as well as their applications in cancer diagnosis, staging, and monitoring therapeutic response.
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Affiliation(s)
- Metasebya Solomon
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo., USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Mo., USA
| | - Yang Liu
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo., USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Mo., USA
| | - Mikhail Y. Berezin
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo., USA
| | - Samuel Achilefu
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo., USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Mo., USA
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, Mo., USA
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Abstract
Barrett's esophagus (BE) is defined as abnormal specialized columnar metaplasia with intestinalization in place of the normal squamous esophageal epithelium. Gastroesophageal reflux disease is a known risk factor for BE; nonetheless BE is also detected in asymptomatic individuals. Other risk factors for BE include smoking, male gender, age over 50 and obesity. Patients diagnosed with BE (without dysplasia) are recommended to undergo endoscopic surveillance every 3-5 years. Advances in imaging techniques (such as narrow band imaging, autofluorescence imaging and confocal laser endomicroscopy) have the potential to improve the detection of dysplasia and early cancer, thus making surveillance a more cost-effective endeavor. Patients with high grade dysplasia (HGD) and early cancer have a high rate of progression to invasive adenocarcinoma and traditionally these patients were treated with esophagectomy. The rapid advancement of endoscopic therapeutic techniques along with a low risk of complications have made endoscopic therapy an acceptable alternative to an esophagectomy in patients with HGD and early cancer. Several endoscopic treatment techniques such as endoscopic mucosal resection, multipolar electrocoagulation, photodynamic therapy, argon plasma coagulation, cryotherapy, and radiofrequency ablation have been studied for endoscopic treatment.
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Affiliation(s)
- Srinivas Gaddam
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA
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27
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McGinty J, Galletly NP, Dunsby C, Munro I, Elson DS, Requejo-Isidro J, Cohen P, Ahmad R, Forsyth A, Thillainayagam AV, Neil MAA, French PMW, Stamp GW. Wide-field fluorescence lifetime imaging of cancer. BIOMEDICAL OPTICS EXPRESS 2010; 1:627-640. [PMID: 21258496 PMCID: PMC3017991 DOI: 10.1364/boe.1.000627] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 08/17/2010] [Accepted: 08/17/2010] [Indexed: 05/20/2023]
Abstract
Optical imaging of tissue autofluorescence has the potential to provide rapid label-free screening and detection of surface tumors for clinical applications, including when combined with endoscopy. Quantitative imaging of intensity-based contrast is notoriously difficult and spectrally resolved imaging does not always provide sufficient contrast. We demonstrate that fluorescence lifetime imaging (FLIM) applied to intrinsic tissue autofluorescence can directly contrast a range of surface tissue tumors, including in gastrointestinal tissues, using compact, clinically deployable instrumentation achieving wide-field fluorescence lifetime images of unprecedented clarity. Statistically significant contrast is observed between cancerous and healthy colon tissue for FLIM with excitation at 355 nm. To illustrate the clinical potential, wide-field fluorescence lifetime images of unstained ex vivo tissue have been acquired at near video rate, which is an important step towards real-time FLIM for diagnostic and interoperative imaging, including for screening and image-guided biopsy applications.
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Affiliation(s)
- James McGinty
- Photonics Group, Department of Physics, Imperial College London, South Kensington Campus, London,
SW7 2AZ, UK
| | - Neil P. Galletly
- Department of Histopathology, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Chris Dunsby
- Photonics Group, Department of Physics, Imperial College London, South Kensington Campus, London,
SW7 2AZ, UK
- Department of Histopathology, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Ian Munro
- Photonics Group, Department of Physics, Imperial College London, South Kensington Campus, London,
SW7 2AZ, UK
| | - Daniel S. Elson
- Photonics Group, Department of Physics, Imperial College London, South Kensington Campus, London,
SW7 2AZ, UK
| | - Jose Requejo-Isidro
- Photonics Group, Department of Physics, Imperial College London, South Kensington Campus, London,
SW7 2AZ, UK
| | - Patrizia Cohen
- Department of Histopathology, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Raida Ahmad
- Department of Histopathology, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Amanda Forsyth
- Department of Histopathology, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Andrew V. Thillainayagam
- Department of Gastroenterology, Division of Medicine, Imperial College London, Hammersmith Hospital Campus, London, W12 0NN, UK
| | - Mark A. A. Neil
- Photonics Group, Department of Physics, Imperial College London, South Kensington Campus, London,
SW7 2AZ, UK
| | - Paul M. W. French
- Photonics Group, Department of Physics, Imperial College London, South Kensington Campus, London,
SW7 2AZ, UK
| | - Gordon W Stamp
- Department of Histopathology, Imperial College London, Du Cane Road, London, W12 0NN, UK
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Endoscopic techniques for recognizing neoplasia in Barrett's esophagus: which should the clinician use? Curr Opin Gastroenterol 2010; 26:352-60. [PMID: 20571387 DOI: 10.1097/mog.0b013e32833ad5c4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The key to prevention and cure of esophageal adenocarcinoma is the detection and eradication of neoplasia in patients with Barrett's esophagus. Multiple tools and technologies are emerging for this purpose. RECENT FINDINGS A detailed white light examination with high-resolution endoscopy and recognition of lesions is paramount. A variety of imaging modalities are being studied for the detection of neoplasia in Barrett's esophagus. Chromoendoscopy, narrow band imaging, and autofluorescence provide a way to target suspicious areas. Confocal endomicroscopy and optical coherence tomography are means to pinpoint imaging to obtain information about the tissue microarchitecture. SUMMARY The key to detection of neoplasia is a careful white light examination with high-resolution endoscopy and recognition of lesion characteristics. Additional imaging modalities may enhance targeting of lesions or provide more information at a focused level. Many of these modalities have yet to be validated in prospective randomized, multicenter trials.
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Abstract
Many developments have been made in the field of Barrett esophagus that have tremendous clinical implications. There are new definitions of Barrett esophagus that have had an immediate clinical impact on cancer risk and screening. Of interest is the definition by the British Society of Gastroenterology, which does not require the presence of intestinal metaplasia for a diagnosis of Barrett esophagus. Imaging techniques that allow improved visualization of intestinal metaplasia at the cellular level are now being used in clinical practice. New hypotheses elucidating the progression from squamous epithelium to intestinal metaplasia have been proposed. Indeed, the crucial role that transcription factors have in the pathogenesis of Barrett esophagus has been clarified. Improved characterization of the molecular mechanisms underlying Barrett esophagus is an incentive to undertake more basic science research in this field. Such research could also help with the development of chemoprevention strategies for this precancerous condition. This Review discusses the advances in understanding of the pathogenesis, diagnosis and treatment of Barrett esophagus.
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Affiliation(s)
- Rami J Badreddine
- Salem Gastroenterology Associates, 1830 S. Hawthorne Road, Winston-Salem, NC 27103, USA.
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30
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Endoluminal MR imaging of porcine gastric structure in vivo. J Gastroenterol 2010; 45:600-7. [PMID: 20087608 DOI: 10.1007/s00535-010-0201-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 01/04/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Recently, several new endoscopic instruments have been developed. However, even with the full use of current modalities, the safety of endoscopic surgery is not guaranteed. Information regarding factors such as fibrosis and the blood vessels under the mucosa is very important for avoiding procedure-related complications. The aim of this study was to define the detailed anatomy of the gastric wall structure in vivo using original endoluminal radiofrequency coils for safer endoscopic therapy. METHODS Swine were used as the subjects and controlled with general anesthesia. Anatomical images were obtained with T1-weighted fast spin echo (T1FSE) and T2-weighted fast spin echo (T2FSE). Dynamic magnetic resonance (MR) angiography was also obtained with three-dimensional T1-weighted fast spoiled gradient recalled acquisition in the steady state (3D-DMRA) following the injection of hyaluronic acid sodium into the submucosal layer. RESULTS Porcine gastric wall structure was visualized, and four layers were discriminated in the T1FSE and T2FSE images. The vascular structure was clearly recognized in the submucosa on 3D-DMRA. CONCLUSION Endoluminal MR imaging was able to visualize the porcine stomach with similar quality to endoscopic ultrasonography imaging. Additionally, it was possible to visualize the vascular structures in the submucosal layer. This is the first report to show that blood vessels under the gastric mucosa can be depicted in vivo.
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Thia KTJ, Kong CSC, Ooi CJ. Narrow Band Imaging and Autofluorescence Imaging for the Detection and Optical Diagnosis of Colorectal Polyps. PROCEEDINGS OF SINGAPORE HEALTHCARE 2010. [DOI: 10.1177/201010581001900107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Colorectal cancer is the most common cancer in Singapore and polyps which are detected during screening colonoscopy are routinely removed. Conventional white light colonoscopy has a substantial miss-rate for polyps and limited accuracy in differentiating neoplastic from non-neoplastic polyps. Dye-based chromoendoscopy and more recent equipment-based image enhanced endoscopic techniques such as narrow-band imaging (NBI) and autofluorescence imaging (AFI) are promising tools to improve polyp detection and optical diagnosis. Current evidence suggests that NBI may not be superior compared to high definition white-light for polyp detection, but it achieves excellent accuracy in polyp characterisation, approaching that of histopathology. AFI is a wide area scanning modality which functions as a red-flag technique to improve polyp detection, although the evidence is still evolving. The ability to accurately characterise polyps with NBI and AFI will guide the management of polyps and in some cases, avoid unnecessary polypectomy and routine histopathology. This has potential to reduce associated costs and risks of polypectomy, and improves on overall efficiency of screening colonoscopy. The review will discuss the technology, current evidence and the issues relevant to the role of NBI and AFI for the detection and optical diagnosis of polyps in colorectal cancer screening.
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Affiliation(s)
- Kelvin Teck-Joo Thia
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Chris San-Choon Kong
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Choon-Jin Ooi
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
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