Optical Biopsy of the Upper GI Tract Using Fluorescence Lifetime and Spectra.

Zhaojun Nie,David Armstrong,Michelle Lepalud,M Jamal Deen,Qiyin Fang,Frances Tse,Fares Badr,Louis W C Liu,Shu-Chi Allison Yeh

doi:10.3389/fphys.2020.00339

Abstract

Screening and surveillance for gastrointestinal (GI) cancers by endoscope guided biopsy is invasive, time consuming, and has the potential for sampling error. Tissue endogenous fluorescence spectra contain biochemical and physiological information, which may enable real-time, objective diagnosis. We first briefly reviewed optical biopsy modalities for GI cancer diagnosis with a focus on fluorescence-based techniques. In an ex vivo pilot clinical study, we measured fluorescence spectra and lifetime on fresh biopsy specimens obtained during routine upper GI screening procedures. Our results demonstrated the feasibility of rapid acquisition of time-resolved fluorescence (TRF) spectra from fresh GI mucosal specimens. We also identified spectroscopic signatures that can differentiate between normal mucosal samples obtained from the esophagus, stomach, and duodenum.

Highlights

Malignancies in the upper gastrointestinal (GI) tract have remained prevalent in the past few decades (American Cancer Society, 2019)
Taking esophageal adenocarcinoma (EAC) as an example, a typical progression path starts with chronic gastroesophageal reflux disease (GERD), which is a common condition with a prevalence of 18–28% in North America (El-Serag et al, 2014)
Autofluorescence imaging has been explored quite extensively mainly based on the loss of collagen in early neoplastic transformation and enhanced cell metabolism that results in reduction of blue fluorescence and an overall red-tinted lesion

Summary

Introduction

Malignancies in the upper gastrointestinal (GI) tract have remained prevalent in the past few decades (American Cancer Society, 2019). As of 2019, the 5-year survival rates of esophageal and stomach cancer combining all stages are 19 and 31%, respectively (American Cancer Society, 2019). The average survival rate is approximately 10-fold higher when the cancer is detected in situ compared to late stage diagnosis (American Cancer Society, 2019). Taking esophageal adenocarcinoma (EAC) as an example, a typical progression path starts with chronic gastroesophageal reflux disease (GERD), which is a common condition with a prevalence of 18–28% in North America (El-Serag et al, 2014). Gastroesophageal reflux causes chronic injury to the normal stratified squamous epithelium which, in about 20% of individuals (Schlottmann et al, 2017), is replaced by columnar-lined epithelium (CLE) in the distal esophagus, a process called columnar metaplasia. In the United States, CLE with IM is the diagnostic criterion for Barrett’s

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