Optical molecular imaging for detection of Barrett’s-associated neoplasia

Table 1 Advantages and disadvantages of optical technologies for identification of neoplasia in Barrett’s esophagus

Technology	Advantages	Disadvantages	Stage of clinical translation
Standard WLE	Capable of scanning wide area, widely available outside of tertiary care centers, no exogenous contrast	Limited sensitivity and specificity	Commercially available
High-definition WLE	Capable of scanning wide area, increased image contrast, no exogenous contrast	Performance evaluated in moderate-sized studies	Commercially available
AFI	Capable of scanning wide area, consistently high sensitivity, no exogenous contrast	High rate of false positives, performance evaluated only in small pilot studies	Commercially available
NBI	Capable of scanning wide area, consistently high sensitivity, no exogenous contrast	Performance evaluated in small pilot studies	Commercially available
OCT	Resolves subsurface structure, no exogenous contrast	Technology still under development	Clinical studies
Endocytoscopy	Histology-like imaging, high specificity	Low sensitivity, limited field of view, requires exogenous contrast	Commercially available
CME	Nuclear morphology can be viewed, high sensitivity and specificity	Limited field of view, high cost, uses IV exogenous contrast	Commercially available
High-resolution microendoscopy	Some nuclear morphology can be viewed, lower cost, adaptable to any endoscope	Limited field of view, requires exogenous contrast, technology still in development	Clinical studies

AFI: Autofluorescence imaging; OCT: Optical coherence tomography; CME: Confocal microendoscopy; WLE: White-light endoscopy; NBI: Narrow-band imaging.

Table 2 Summary of performance of emerging optical technologies

Type of detection	Study size	Sensitivity, specificity
AFI	60 patients, 116 images	91%, 43%[36]
NBI	63 patients, 175 images	94%, 76%[33]
	51 patients, 204 images	100%, 98%[34]
	21 patients, 75 images	89%, 95%[38]
High-resolution imaging (1-15 μm resolution)
OCT	33 patients, 314 images	68%, 82%[43]
	55 patients, 177 images	83%, 75%[58]
Endocytoscopy	16 patients, 166 images	56%, 68% (425 ×)
		42%, 83% (1125 ×)[47]
Confocal imaging	63 patients, 433 images	93%, 98%[48]
	38 patients, 296 images	75%, 90%[50]

AFI: Autofluorescence imaging; OCT: Optical coherence tomography; NBI: Narrow-band imaging.