Fluorescence Endomicroscopy Research Articles

Imaging of goblet cells as a marker for intestinal metaplasia of the stomach by one-photon and two-photon fluorescence endomicroscopy

Goblet cells are a requirement for the diagnosis of intestinal metaplasia of the stomach. The gastric mucosa is lined by a monolayer of columnar epithelium with some specialization at the crypts, but there are no goblet cells in normal gastric epithelium. The appearance of goblet cells in gastric epithelium is an indicator of potential malignant progression toward adenocarcinoma. Therefore, in vivo three-dimensional imaging of goblet cells is essential for diagnoses of a premalignant stage of gastric cancers called intestinal metaplasia. We used mouse intestine, which has goblet cells, as a model of intestinal metaplasia. One-photon confocal fluorescence endomicroscopy and two-photon fluorescence endomicroscopy are employed for 3-D imaging of goblet cells. The penetration depth, the sectioning ability, and the photobleaching information of imaging are demonstrated. Both endomicroscopy techniques can three-dimensionally observe goblet cells in mouse large intestine and achieve an imaging depth of 176 microm. The two-photon fluorescence endomicroscopy shows higher resolution and contrast of the imaging sections at each depth. In addition, two-photon fluorescence endomicroscopy also has advantages of sectioning ability and less photobleaching. These results prove that two-photon fluorescence endomicroscopy is advantageous in diagnoses of a premalignant stage of gastric cancers.

Fluorescence endomicroscopy with structured illumination

We present an endomicroscope apparatus that utilizes structured illumination to produce high resolution (approximately 2.6 microm) optically sectioned fluorescence images over a field of view of about 240 microm. The endomicroscope is based on the use of a flexible imaging fiber bundle with a miniaturized objective. We also present a strategy to largely suppress structured illumination artifacts that arise when imaging in thick tissue that exhibits significant out-of-focus background. To establish the potential of our endomicroscope for preclinical or clinical applications, we provide images of BCECF-AM labeled rat colonic mucosa.

DEVELOPMENT OF A LASER CONFOCAL ENDOMICROSCOPE FOR IN VIVO FLUORESCENCE IMAGING

Malignancies of the oral cavity are conventionally diagnosed by white light endoscopy, biopsy and histopathology. However, it is often difficult to distinguish between benign lesions and premalignant or early lesions. There is a need for a more definitive, non-invasive technique for diagnosis of oral cavity lesions. A laser confocal endomicroscope offers non-invasive surface and subsurface imaging of tissue. We investigated its potential for fluorescence imaging of the oral cavity using hypericin, fluorescein and aminolevulinic acid. Fluorescence imaging was carried out both in vivo and on resected tissue samples of the oral cavity in both humans and animal models. Good structural images of the oral cavity were obtained. Morphological differences between normal and lesion tissue can be distinguished. The use of Pharmasolve® enhanced the subsurface depth from which images can be obtained. Our results show that laser confocal fluorescence endomicroscopy has great potential for the diagnosis of oral cavity malignancies.

Fluorescence and Spectral Imaging

Early identification of dysplasia remains a critical goal for diagnostic endoscopy since early discovery directly improves patient survival because it allows endoscopic or surgical intervention with disease localized without lymph node involvement. Clinical studies have successfully used tissue autofluorescence with conventional white light endoscopy and biopsy for detecting adenomatous colonic polyps, differentiating benign hyperplastic from adenomas with acceptable sensitivity and specificity. In Barrett's esophagus, the detection of dysplasia remains problematic because of background inflammation, whereas in the squamous esophagus, autofluorescence imaging appears to be more dependable. Point fluorescence spectroscopy, although playing a crucial role in the pioneering mechanistic development of fluorescence endoscopic imaging, does not seem to have a current function in endoscopy because of its nontargeted sampling and suboptimal sensitivity and specificity. Other point spectroscopic modalities, such as Raman spectroscopy and elastic light scattering, continue to be evaluated in clinical studies, but still suffer the significant disadvantages of being random and nonimaging. A recent addition to the fluorescence endoscopic imaging arsenal is the use of confocal fluorescence endomicroscopy, which provides real-time optical biopsy for the first time. To improve detection of dysplasia in the gastrointestinal tract, a new and exciting development has been the use of exogenous fluorescence contrast probes that specifically target a variety of disease-related cellular biomarkers using conventional fluorescent dyes and novel potent fluorescent nanocrystals (i.e., quantum dots). This is an area of great promise, but still in its infancy, and preclinical studies are currently under way.

Laser confocal endomicroscopy as a novel technique for fluorescence diagnostic imaging of the oral cavity

Malignancies of the oral cavity are conventionally diagnosed by white light endoscopy, biopsy, and histopathology. However, it is often difficult to distinguish between benign and premalignant or early lesions. A laser confocal endomicroscope (LCE) offers noninvasive, in vivo surface and subsurface fluorescence imaging of tissue. We investigate the use of an LCE with a rigid probe for diagnostic imaging of the oral cavity. Fluorescein and 5-aminolevulinic acid (ALA) were used to carry out fluorescence imaging in vivo and on resected tissue samples of the oral cavity. In human subjects, ALA-induced protoporphyrin IX (PpIX) fluorescence images from the normal tongue were compared to images obtained from patients with squamous cell carcinoma (SCC) of the tongue. Using rat models, images from normal rat tongues were compared to those from carcinogen-induced models of SCC. Good structural images of the oral cavity were obtained using ALA and fluorescein, and morphological differences between normal and lesion tissue can be distinguished. The use of a pharmaceutical-grade solvent Pharmasolve enhanced the subsurface depth from which images can be obtained. Our initial results show that laser confocal fluorescence endomicroscopy has potential as a noninvasive optical imaging method for the diagnosis of oral cavity malignancies.

Endoscopic Confocal Imaging

In vivo fluorescence endomicroscopy is a newly developed diagnostic tool enabling virtual in vivo histology of the mucosal layer during ongoing endoscopy. This review summarizes currently available data about the technique and clinical use of confocal endomicroscopy. Indications discussed include colorectal cancer evaluation, ulcerative colitis and surveillance, Barrett's esophagus, and detection of Helicobacter pylori infection in vivo.