Abstract
Current imaging tools are associated with inconsistent sensitivity and specificity for detection of Barrett's-associated neoplasia. Optical imaging has shown promise in improving the classification of neoplasia in vivo. The goal of this pilot study was to evaluate whether in vivo vital dye fluorescence imaging (VFI) has the potential to improve the accuracy of early-detection of Barrett's-associated neoplasia. In vivo endoscopic VFI images were collected from 65 sites in 14 patients with confirmed Barrett's esophagus (BE), dysplasia, oresophageal adenocarcinoma using a modular video endoscope and a high-resolution microendoscope(HRME). Qualitative image features were compared to histology; VFI and HRME images show changes in glandular structure associated with neoplastic progression. Quantitative image features in VFI images were identified for objective image classification of metaplasia and neoplasia, and a diagnostic algorithm was developed using leave-one-out cross validation. Three image features extracted from VFI images were used to classify tissue as neoplastic or not with a sensitivity of 87.8% and a specificity of 77.6% (AUC = 0.878). A multimodal approach incorporating VFI and HRME imaging can delineate epithelial changes present in Barrett's-associated neoplasia. Quantitative analysis of VFI images may provide a means for objective interpretation of BE during surveillance.
Highlights
The incidence of esophageal adenocarcinoma (EAC) has increased at an alarming rate over the last four decades
In vivo images were obtained from 72 sites in 14 patients with biopsy confirmed metaplasia or neoplasia
We report results from an in vivo study to assess the classification potential of vital dye fluorescence imaging (VFI) using quantitative image features
Summary
The incidence of esophageal adenocarcinoma (EAC) has increased at an alarming rate over the last four decades. Since 1975, there has been a 463% increase among men and 335% increase among women.[1] This dramatic increase is concerning due to the very low 5-year survival rate (12%) associated with the disease, which is often diagnosed at a late stage.[2] if detected early, the 5-year survival rate can be as high as 81%; only a small fraction of esophageal cancers is detected at an early stage.[3].
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