Abstract
Esophageal adenocarcinoma is the most rapidly growing cancer in America. Although the prognosis after diagnosis is unfavorable, the chance of a successful outcome increases tremendously if detected early while the lesion is still dysplastic. Unfortunately, the present standard-of-care, endoscopic surveillance, has major limitations, since dysplasia is invisible, often focal, and systematic biopsies typically sample less than one percent of the esophageal lining and therefore easily miss malignancies. To solve this problem we developed a multispectral light scattering endoscopic imaging system. It surveys the entire esophageal lining and accurately detects subcellular dysplastic changes. The system combines light scattering spectroscopy, which detects and identifies invisible dysplastic sites by analyzing light scattered from epithelial cells, with rapid scanning of the entire esophageal lining using a collimated broadband light beam delivered by an endoscopically compatible fiber optic probe. Here we report the results of the first comprehensive multispectral imaging study, conducted as part of routine endoscopic procedures performed on patients with suspected dysplasia. In a double-blind study that characterized the system’s ability to serve as a screening tool, 55 out of 57 patients were diagnosed correctly. In addition, a smaller double-blind comparison of the multispectral data in 24 patients with subsequent pathology at locations where 411 biopsies were collected yielded an accuracy of 90% in detecting individual locations of dysplasia, demonstrating the capability of this method to serve as a guide for biopsy.
Highlights
Esophageal cancer is the fifth leading cause of cancer deaths worldwide[1]
The main stumbling block in visualizing dysplasia in Barrett’s esophagus (BE) is the need for a single technique to simultaneously achieve subcellular scale sensitivity and anatomic scale imaging. To overcome this problem we developed a multispectral imaging system that combines light scattering spectroscopy (LSS), which analyzes light scattered from epithelial cells, thereby identifying otherwise invisible dysplastic sites[24], with rapid scanning of the entire esophageal lining by a collimated broadband light beam, delivered by an endoscopically compatible fiber optic probe[25]
We show the histology images from biopsies collected during the procedure for two of the locations marked on this map, with one of the locations later diagnosed as Non-dysplastic Barrett (NDB) and another as high grade dysplasia (HGD)
Summary
The two primary types of esophageal cancer are adenocarcinoma and squamous cell carcinoma. The former is the leading esophageal malignancy in the Western world. Esophageal adenocarcinoma is the malignancy that has been rising the fastest in the United States over the past four decades[2,3]. It has very poor prognosis with less than 16% of patients alive five years after diagnosis. Barrett’s esophagus (BE), a potentially precancerous condition which may arise in the setting of gastroesophageal reflux, precedes almost all cases of adenocarcinoma, with ~ 3 million Americans affected. Some groups advocate treating Barrett’s with LGD, the rate of cancer progression in untreated LGD patients is still a matter of ongoing investigation[6]
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