Endocytoscopy System Research Articles

Nuclear segmentation based on endocytoscopy system with high magnification

Nuclear segmentation based on endocytoscopy system with high magnification

Endocytoscopic observation with methylene blue staining for duodenal neoplasms associated with familial adenomatous polyposis

Duodenal cancer is a leading cause of death after colectomy in patients with familial adenomatous polyposis (FAP). Detailed endoscopic evaluation of duodenal lesions with potential for carcinoma development is therefore mandatory. Here we investigated the features of duodenal lesions in FAP patients using an endocytoscopy system (ECS). We retrospectively reviewed duodenal lesions in 15 cases of FAP using an ECS (GIF-H290EC) with methylene blue (MB) as the vital dye. With reference to the Spigelman classification, we investigated the number of lesions using white light (WL), narrow-band imaging (NBI), and MB staining. Using the maximum magnification power of the ECS we investigated the histology (duct openings or finger-like projections) and grade of dysplasia (presence or absence of enlarged oval-shaped nuclei) of the lesions. The number of duodenal lesions increased in ascending order of WL, NBI, and MB (P < 0.05). Among 51 MB-unstained lesions, 46 (90.2%) were proven to be duodenal neoplasms histologically. Duct openings were seen in 90.2% of tubular adenomas and tubulovillous adenomas. Finger-like projections were seen in 33.3% of tubular adenomas and in 88.2% of tubulovillous adenomas. Enlarged oval-shaped nuclei were observed in 100% of duodenal cancers, 33.3% of high-grade adenomas, and 9.4% of low-grade adenomas. MB staining allows more accurate detection of duodenal neoplasms in comparison to conventional WL and NBI observation. In cases of FAP, use of the maximum magnification power of the ECS may allow selection of lesions with high malignant potential.

Acrinol: Dye with potential for nuclear staining in confocal laser endomicroscopy.

Confocal laser endomicroscopy (CLE)1) and endocytoscopy system (ECS)2) have made optical biopsy in the digestive tract a reality. However, for omission of biopsy histology, visualization of nuclei is essential. In ECS, nuclei can be observed after vital staining with methylene blue, toluidine blue etc.3), and vital staining in CLE requires venous injection or spraying of fluorescein into the gastrointestinal lumen4). However, fluorescein does not stain nuclei. Acriflavin, a topical antiseptic drug, can stain nuclei for CLE observation5), but it has not been widely used because of associated adverse events. This article is protected by copyright. All rights reserved.

A newly developed continuous zoom-focus endocytoscope.

Background and study aims We report the features of a newly developed endocytoscopy system (ECS), the GIF-Y0074. Patients and methods The GIF-Y0074 offers high-definition resolution with a consecutive increase of magnification to × 500. Using ECS, we observed 32 cases of esophageal squamous cell carcinoma (ESCC), 11 cases of gastric cancer, and five cases of duodenal adenoma. Results The images of cells obtained using the GIF-Y0074 at maximum magnification were brighter and clearer than those obtained with previous ECS systems. For diagnosis of ESCC, clearer visualization of the nucleus made nuclear abnormality easier to recognize. Cancer cells were visualized in 10/11 cases of gastric cancer, but removal of mucus still remained a problem. Duodenal adenomas were found to have atypical cells with villi and tubules at the mucosal surface, thus assisting their histological diagnosis in vivo. Conclusion The GIF-Y0074 is an excellent ECS in terms of ease of use, satisfactory resolution, and magnification power, and therefore achieves a level of utility that makes its commercial release justifiable. This ECS heralds a new era of endoscopic and histological diagnosis.

Application and Efficacy of Super-Magnifying Endoscopy for the Lower Intestinal Tract.

Endoscopy plays a significant role in the diagnosis, management, and surveillance of colorectal cancer (CRC) and inflammatory bowel diseases (IBDs). Moreover, magnifying endoscopy and image-enhanced endoscopy has a crucial role in the clinical setting. Recently, a super-magnifying endoscope has been developed, and two devices, confocal laser endomicroscopy (CLE) and an endocytoscopy system (ECS), which allow in vivo microscopic inspection of the microstructural mucosal features of the gastrointestinal tract, are currently available. Studies on the use of ECS in CRC were reported by a Japanese group. Additionally, a few studies on the use of ECS in IBD have been reported. CLE has been shown to be reliable in assessing the activity of the disease in IBDs in both ulcerative colitis and Crohn’s disease. Various published studies evaluated the use of CLE during colonoscopy to distinguish colorectal polyp pathology and neoplasia. However, these studies are heterogeneous, and further evidence is necessary to confirm the efficacy of CLE.

Endocytoscopic observation of various types of esophagitis

Background Use of an endocytoscopy system (ECS) makes it possible to omit biopsy histology for esophageal squamous cell carcinoma (ESCC). However, for differential diagnosis of ESCC, the endocytoscopic characteristics of esophagitis should be clarified.

Tu1522 Implementing Chromoendoscopy for Surveillance in Inflammatory Bowel Disease Does Not Increase Dysplasia Detection Compared to Conventional Colonoscopy With Random Biopsies: a Retrospective Study

Tu1522 Implementing Chromoendoscopy for Surveillance in Inflammatory Bowel Disease Does Not Increase Dysplasia Detection Compared to Conventional Colonoscopy With Random Biopsies: a Retrospective Study

Real-Time Endoscopic Pathology Assessment of Colorectal Polyps

Determining the pathology of colorectal polyps in real-time has been the subject of many studies. Polyp pathology has been estimated using white light endoscopy, narrow band imaging with and without optical magnification, the Fujinon Intelligent Chromo Endoscopy system, the Pentax i-scan, confocal laser microscopy, autofluorescence, and the endocytoscopy system. Nearly all the technologies have had a substantial degree of success, with the largest number of studies performed using narrow band imaging. The persistent and nagging question is whether the use of these technologies can have an impact on everyday clinical practice, because, althoughtheyhavebeenavailableinsomecasesfor morethan a decade, they currently do not have a meaningful role in routine endoscopic practice. Numerous obstacles to the implementation of real-time pathology in practice are still present. These include lack of reimbursement, and consequently a lack of motivation for many endoscopists. Second, in many locations, all surgically removedtissuemustbesentforpathologicevaluation.Finally,

Endoscopic in vivo cellular imaging of superficial squamous cell carcinoma of the head and neck by using an integrated endocytoscopy system (with video)

Recently, some patients have been found to have superficial squamous cell carcinoma (SCC) of the head and neck region during GI endoscopy; however, endoscopic biopsy from a lesion in the head and neck region is troublesome. An endocytoscopy system has been reported to enable optical biopsy of an esophageal lesion. To evaluate the feasibility of invivo cellular imaging with an integrated endocytoscopy system for patients with superficial SCC of the head and neck. Experimental pilot study. University hospital. This study involved 12 patients who were found to have superficial SCC of the head and neck during GIendoscopy. Endocytoscopic images were taken of each lesion and of the surrounding mucosa. The images were later reviewed by 1 pathologist and 2 endoscopists who were unaware of any other findings. Correlation between endocytoscopy diagnosis and histologic diagnosis. Adequate endocytoscopic images could be obtained in 11 of the 12 patients (15 of 16 lesions). For endocytoscopic images of 15 lesions and 12 areas of surrounding mucosa, the overall accuracy of endocytoscopic diagnosis in differentiating between nonmalignant and malignant histopathology by the pathologist, endoscopist 1, and endoscopist 2 were 96%, 96%, and 96%, respectively. The kappa value for interobserver agreement was0.77. Single-center experience, small number of patients. An endocytoscopy system has the potential to be used as an optical biopsy for superficial head and neck lesions.

Real-time in vivo histologic examination using a probe-based endocytoscopy system for differentiating duodenal polyps

Real-time in vivo histologic examination using a probe-based endocytoscopy system for differentiating duodenal polyps

Bronchoscopic Observation of Endobronchial Tumor Cells

A 68-year-old woman presented with cough and dyspnea. Chest x-ray film and computed tomography revealed atelectasis in the right upper lobe. She had a history of a bladder neoplasm, which was treated by cystectomy and chemotherapy. Flexible bronchoscopy revealed a polypoid tumor in the right upper lobe bronchus, protruding into the right main bronchus. Further, we observed the surface of the tumor by using the endocytoscopy system. The endocytoscopy system showed oval-shaped tumor cells with prominent nuclei on the surface of the tumor with a methylene blue dye staining. Biopsied specimen of the tumor demonstrated foci of metastatic urothelial carcinoma. These cancer cells were similar to the cell images of endocytoscopy system. This technology may have the potential to provide pathologic diagnosis during bronchoscopy.

Sa1589 Evaluation of Colorectal Mucosal and Neoplastic Vascular Characteristics by Use of Endocytoscopic-Narrow Band Imaging (EC-NBI)

Magnifying narrow band imaging (NBI) emphasizes the surface microvasculature of the gastrointestinal tract. The endocytoscopy (EC) system enables cells and nuclei to be observed at 450-fold magnification during gastrointestinal endoscopy. Kudo et al. reported that EC system was useful for differentiating between neoplastic and nonneoplastic lesions and between “massively submucosal cancers or worse” and other neoplastic lesions1.

Correlation between endocytoscopy and conventional histopathology in microstructural features of ulcerative colitis

Routine diagnosis of the histopathological activity of ulcerative colitis (UC) requires multiple biopsy samples, and an endocytoscopy system (ECS) provides real-time ultra-magnifying microscopic imaging in vivo. We have established an ECS score (ECSS) to determine a histopathological activity index of UC. Fifty-five UC patients (mean age 40.7 years; 67% men) were enrolled. A super-magnifying ECS with magnification 450× was used, and sample biopsies were obtained. Matts' histopathological grade was determined, to evaluate disease severity, by two pathologists, with consensus. The ECSS of UC was independently determined by at least two investigators, with consensus. In total, 76 pairs of ECSS and Matts' histopathological grades were independently acquired. To validate the ECSS, inter-observer agreement between three endoscopists, with consensus, and another endoscopist, was calculated as the kappa value. We also evaluated the correlation between the ECSS and Matts' histopathological grade, and between the conventional Matts' endoscopic grade and Matts' histopathological grade. The ECSS of UC intestinal mucosa, i.e., the sum of the indices for shape (0-3) and distance between crypts (0-2), and the visibility of superficial microvessels (0-1), showed a strong correlation with Matts' histopathological grades (ρ = 0.713, P < 0.001); as well, there was a strong correlation between the conventional Matts' endoscopic grade and Matts' histopathological grade (ρ = 0.694, P < 0.001). Furthermore, the ECSS showed high reproducibility (κ = 0.79, 95% confidence interval [CI] 0.71-0.87). Our novel ECSS has good predictive value for the histopathological activity of UC.

Su1525 Vascular Features of Colorectal Mucosa and Neoplasia With Endocytoscopic-Narrow Band Imaging (EC-NBI): A Pilot Study

Vascular Features of Colorectal Mucosa and Neoplasia With Endocytoscopic-Narrow Band Imaging (EC-NBI): A Pilot Study Yoshiki Wada, Shin-Ei Kudo, Masashi Misawa, Takemasa Hayashi, Kunihiko Wakamura, Yuichi Mori, Nobunao Ikehara Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan Background: Narrow-band imaging (NBI) emphasizes the surface microvasculature of the gastrointestinal tract. The endocytoscopy (EC) system is a recent developed technique which in contrast to others, such as confocal endomicroscopy, does not require fluorescein administration. Recent pilot studies have suggested the potential of EC to enable microscopic observation at the cellular level in vivo and to diagnose malignant lesions in esophagus and colon. Aim: The aim of this study was to evaluate the vessel of colorectal lesions with endocytoscopic narrow band imaging (EC-NBI) in vivo and clarify the vessel feature in tissue characterization. Material and Methods: The subject was compound of 86 consecutive patients who underwent colonoscopy, from Feburuary 2009 to May 2010. A total of 94 lesions (63 adenomas and 31 invasive cancers limited to submucosal layer) were evaluated in 86 patients. In 11 randomly selected cases, the adjacent mucosa of the lesions that looked normal by conventional endoscopy was analyzed. In this study, an integrated type endocytoscope (XCF-Q260EC1, Olympus, Tokyo) providing about 450x magnification power was used. The picture of endocytoscope was regular quadrilateral and not fisheye lens. The length of its side was 426 m and established as the standard. The diameter of vessels in colorectal mucosa or lesions was measured and calculated. Result: The average diameter of normal vessels was 7.8 1.0 m. The average vascular diameter of adenoma was 15.2 5.9 m. Adenomatous vessel thickness was almost uniform and as regular pitted surrounding. The average vascular diameter of submucosal slightly cancer (SMs) was 16.2 6.9 m. That of submucosal massively cancer (SMm) was 24.1 10.1 m. The vascular feature of SMm was unusually large in caliber and with network interruption. The maximum diameter of normal vessels was 9.0 0.6 m. The maximum vascular diameter of adenoma, SMs and SMm were 23.0 5.9 m, 22.7 5.9 m and 36.8 8.2 m respectively. Both average and maximum diameters of neoplastic vessels were greatly larger than those of normal vessels (p .01). Those of submucosal massively cancerous vessels were also greatly larger than those of the other neoplastic vessel types (p .01). Conclusion: EC-NBI allows a real time observation of colorectal vessels. It was possible to distinguish neoplastic from nonneoplastic lesions, and SMm from adenoma/SMs. EC system does not only provide realtime histological images in vivo but also clarifies the vascular features of colorectal mucosa and neoplasia with NBI system.

S36 Check novel in vivo real time imaging of the bronchial mucosa using an endo-cytoscopy

<h3>Objectives</h3> We investigated the capabilities of an Endo-Cytoscopy system (ECS) that enables microscopic imaging of the tracheobronchial tree during bronchoscopy, including normal bronchial epithelium, dysplastic mucosa and hilar lung cancer. <h3>Methods</h3> The newly developed integrated-type ECS for the bronchoscope has a built-in two imaging system with a conventional mode and a high-power endocytoscopic mode. ECS has a high magnification of 570×. Thirty-seven patients including 9 hilar lung cancer, 6 abnormal sputum cytology, 19 squamous dysplasia, and 3 after photodynamic therapy were entered into the study and underwent white light, narrow band imaging and autofluorescence imaging bronchoscopy. Both the abnormal area of interest and surrounding normal bronchial mucosa were stained with 0.5% methylene blue and examined with ECS. Histological examinations with haematoxylin and eosin stain were performed using the biopsied specimens. The ECS imaging was analysed and correlated with the corresponding histological examination. <h3>Results</h3> ECS imaging could distinguish between different types of bronchial epithelium including normal bronchial mucosa, squamous dysplasia, and hilar lung cancer. Squamous dysplasia and hilar lung cancer were predictive with sensitivity of 85.7% (12/14) and 90.9% (10/11) and specificity of 100% (12/12), respectively. These ECS images corresponded well conventional histology. <h3>Conclusion</h3> ECS was useful for the discrimination between normal bronchial epithelial cells and dysplastic cells or malignant cells during bronchoscopy in real time. This novel technology has an excellent potential to provide <i>in vivo</i> diagnosis during bronchoscopic examinations.

In vivo microscopic imaging of the bronchial mucosa using an endo-cytoscopy system

Objectives We investigated the capabilities of an endo-cytoscopy system (ECS) that enables microscopic imaging of the tracheobronchial tree during bronchoscopy, including normal bronchial epithelium, dysplastic mucosa and squamous cell carcinoma. Methods The newly developed ECS has a 3.2 mm diameter that can be passed through the 4.2 mm working channel of a mother endoscope for insertion of the ECS. It has a high magnification of 570× on a 17 in. video monitor. Twenty-two patients (7 squamous cell carcinoma, 11 squamous dysplasia and 4 after PDT therapies) were underwent white light, NBI light and AFI bronchoscopy. Both abnormal areas of interest and normal bronchial mucosa were stained with 0.5% methylene blue and examined with ECS at high magnification (570×). Histological examinations using haematoxylin and eosin staining were made of biopsied specimens. Analyzed ECS images were compared with the corresponding histological examinations. Results In normal bronchial mucosa, ciliated columnar epithelial cells were visible. In bronchial squamous dysplasia, superficial cells with abundant cytoplasm were arranged regularly. In squamous cell carcinoma, large, polymorphic tumor cells showed increased cellular densities with irregular stratified patterns. These ECS images corresponded well with the light-microscopic examination of conventional histology. Conclusion ECS was useful for the discrimination between normal bronchial epithelial cells and dysplastic cells or malignant cells during bronchoscopy in real time. This novel technology has an excellent potential to provide in vivo diagnosis during bronchoscopic examinations.

In vivo visualization of trophozoites in patients with amoebic colitis by using a newly developed endocytoscope

The endocytoscopy system (ECS) is a new method to provide real-time super-magnifying microscopic imaging in vivo. Routine diagnosis of amebic colitis requires multiple tests that are both time consuming and costly. To determine the feasibility of ECS to directly detect the amebic parasites in vivo. Prospective, single-center, pilot study. Tertiary-care university hospital. This study involved 5 patients who were suspected to have amebic colitis by conventional colonoscopy in our institute. A super-magnifying ECS with 450 x magnification. We compared ECS findings with those of conventional methods-serum antibody tests and histology of colon biopsy specimens. We successfully visualized the amebic trophozoites in all 5 cases. In contrast, 3 specimens had positive results on serology, and 3 had positive histology results on hematoxylin and eosin staining. Pilot study with a limited number of patients. Findings were compared only with serology and histology findings. ECS would be a useful tool for the prompt diagnosis of amebic colitis via the real-time in vivo visualization of amebic trophozoites.

ENDOCYTOSCOPIC OBSERVATION OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA

The endocytoscopy system (ECS), adapted for clinical use in 2003, is an ultra-high-power magnifying endoscope that allows observations at the cell level. ECS is based on the technology of light-contact microscopy. The most evident use of ECS is for real-time, high-resolution diagnosis of nuclear abnormalities, mainly in patients with esophageal cancer. Up to now, three different types of ECS have been available. This diagnostic tool makes it possible to omit histological examination of biopsy samples in approximately 84% of esophageal squamous cell carcinoma, as evidence for both an increase of cell density and nuclear abnormalities is considered to be convincing proof that a lesion is malignant. Here we describe the features of ECS and the background that led to its development, and review the published literature pertaining to the observation of esophageal neoplasms using ECS.

Endocytoscopy can identify dysplasia in aberrant crypt foci of the colorectum: a prospective in vivo study

A catheter-type endocytoscope has recently been developed that is able to provide in vivo cellular images of gastrointestinal mucosa. Aberrant crypt foci (ACF) represent the earliest precursor of colorectal cancer featuring the dysplasia-carcinoma sequence. The aim of the current study was to assess the potential of the endocytoscopy system (ECS) in the "in vivo" detection of dysplasia in colorectal ACF. Consecutive patients with colorectal ACF were studied with endocytoscopy. Blinded endoscopic and histological assessments were obtained. Lesions were excised en bloc for histology. A total of 48 colorectal lesions were examined in 41 patients. The mean duration of the ECS procedure was 44 +/- 12 minutes (range 31 - 62 minutes). The quality of ECS images was rated as good in 39/48, medium in six, and poor in three (6.2 %). It was possible to observe lesions at the cellular level and evaluate both cellular and structural atypia in vivo. In normal mucosa, crypts had preserved individuality and round-shaped contours. Nuclei were located at the basal third of the crypt in a single line, and the lumen was circular. In dysplastic ACF, crypt contours were polygonal, cell nuclei were elongated with pseudostratification toward the luminal half of the crypt and irregularly arranged, and the lumen was linear. In all, 23 endocytoscopic images were labeled as dysplastic and 25 as nondysplastic. Histology confirmed low-grade dysplasia in 21/23 cases (91.4 % sensitivity). Absence of dysplasia was confirmed in the remaining 25 cases (100 % specificity). Interobserver agreement between trained endoscopist and pathologist was good (wK 0.68; 95 % CI 0.59 - 0.78). Endocytoscopy provides real-time histological images in vivo, with clear visualization of cellular details and features of dysplasia in colorectal ACF.

Endocytoscopy assists in the intraoperative diagnosis of carcinoma in a patient with chronic pancreatitis

The endocytoscopy system has been used successfully for direct histological imaging of the gastrointestinal mucosa during endoscopy [1] [2] [3]. However, there are no published reports on the intraoperative use of the endocytoscope. This is the first report describing the intraoperatiave use of the endocytoscope for the detection of carcinoma in a patient with chronic pancreatitis.