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Endoscopy 2016; 48(02): A1-A13
DOI: 10.1055/s-0034-1392803
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Multimodal endoscope can quantify wide-field fluorescence detection of Barrett’s neoplasia

Bishnu P. Joshi
1   Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
,
Xiyu Duan
2   Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
,
Richard S. Kwon
1   Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
,
Cyrus Piraka
1   Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
,
B. Joseph Elmunzer
1   Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
,
Shaoying Lu
3   Department of General Surgery, First Affiliated Hospital, Medical School of Xi’an Jiaotong University, People’s Republic of China
,
Emily F. Rabinsky
1   Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
,
David G. Beer
4   Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan, USA
,
Henry D. Appelman
5   Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
,
Scott R. Owens
5   Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
,
Rork Kuick
6   University of Michigan Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
,
Nobuyuki Doguchi
7   Olympus Medical Systems Corp., Tokyo, Japan
,
D. Kim Turgeon
1   Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
,
Thomas D. Wang
1   Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
2   Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
8   Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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Publikationsverlauf

submitted 06. März 2015

accepted after revision 01. Juni 2015

Publikationsdatum:
01. Oktober 2015 (online)

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Video Comment on Bishnu P. Joshi et al.Endoscopy 2016; 48(02): v5-v5
DOI: 10.1055/s-0042-101361

Background and study aims: To demonstrate the clinical use of a multimodal endoscope with a targeted fluorescently labeled peptide for quantitative detection of Barrett’s neoplasia.

Patients and methods: We studied 50 patients with Barrett’s esophagus using a prototype multimodal endoscope with a fluorescently labeled peptide. Co-registered fluorescence and reflectance images were converted to ratios to correct for differences in distance and geometry over the image field of view. The ratio images were segmented using a unique threshold that maximized the variance between high and low intensities to localize regions of high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC).

Results: Early neoplasia (HGD and EAC) was identified with 94 % specificity and 96 % positive predictive value at a threshold of 1.49. The mean results for HGD and EAC were significantly greater than those for squamous/Barrett’s esophagus and low grade dysplasia by one-way analysis of variance (ANOVA). The receiver operator characteristic curve for detection of early neoplasia had an area under the curve of 0.884. No adverse events associated with the endoscope or peptide were found.

Conclusion: A multimodal endoscope can quantify fluorescence images from targeted peptides to localize early Barrett’s neoplasia. (ClinicalTrials.gov number NCT01630798.)

Figs. e2 – e5, e9, Supplementary references

 

  • References

  • 1 Longcroft-Wheaton G, Duku M, Mead R et al. Acetic acid spray is an effective tool for the endoscopic detection of neoplasia in patients with Barrett’s esophagus. Clin Gastroenterol Hepatol 2010; 8: 843-847
    CrossrefPubMedGoogle Scholar
  • 2 Sharma P, Hawes RH, Bansal A et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett’s oesophagus: a prospective, international, randomised controlled trial. Gut 2013; 62: 15-21
    CrossrefPubMedGoogle Scholar
  • 3 Boerwinkel DF, Holz JA, Kara MA et al. Effects of autofluorescence imaging on detection and treatment of early neoplasia in patients with Barrett’s esophagus. Clin Gastroenterol Hepatol 2014; 12: 774-781
    CrossrefPubMedGoogle Scholar
  • 4 Sturm MB, Joshi BP, Lu S et al. Targeted imaging of esophageal neoplasia with a fluorescently labeled peptide: first-in-human results. Sci Transl Med 2013; 5: 184ra61
    PubMedGoogle Scholar
  • 5 Sharma P, Dent J, Armstrong D et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392-1399
    CrossrefPubMedGoogle Scholar
  • 6 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-S43
    CrossrefPubMedGoogle Scholar
  • 7 Wang TD, Janes GS, Wang Y et al. Mathematical model of fluorescence endoscopic image formation. Appl Opt 1998; 37: 8103-8111
    CrossrefPubMedGoogle Scholar
  • 8 Otsu N. A threshold selection method from gray-level histograms. Automatica 1975; 11: 285-296
    CrossrefPubMedGoogle Scholar

    • Supplementary references

    • 9 Kariv R, Plesec TP, Goldblum JR et al. The Seattle protocol does not more reliably predict the detection of cancer at the time of esophagectomy than a less intensive surveillance protocol. Clin Gastroenterol Hepatol 2009; 7: 653-658
      CrossrefPubMedGoogle Scholar
    • 10 Canto MI, Setrakian S, Willis JE et al. Methylene blue staining of dysplastic and nondysplastic Barrett’s esophagus: an in vivo and ex vivo study. Endoscopy 2001; 33: 391-400
      Artikel in Thieme ConnectPubMedGoogle Scholar
    • 11 Wo JM, Ray MB, Mayfield-Stokes S et al. Comparison of methylene blue-directed biopsies and conventional biopsies in the detection of intestinal metaplasia and dysplasia in Barrett’s esophagus: a preliminary study. Gastrointest Endosc 2001; 54: 294-301
      CrossrefPubMedGoogle Scholar
    • 12 Ragunath K, Krasner N, Raman VS et al. A randomized, prospective cross-over trial comparing methylene blue-directed biopsy and conventional random biopsy for detecting intestinal metaplasia and dysplasia in Barrett’s esophagus. Endoscopy 2003; 35: 998-1003
      Artikel in Thieme ConnectPubMedGoogle Scholar
    • 13 Kara MA, Smits ME, Rosmolen WD et al. A randomized crossover study comparing light-induced fluorescence endoscopy with standard videoendoscopy for the detection of early neoplasia in Barrett’s esophagus. Gastrointest Endosc 2005; 61: 671-678
      CrossrefPubMedGoogle Scholar
    • 14 Kara MA, Peters FP, Rosmolen WD et al. High-resolution endoscopy plus chromoendoscopy or narrow-band imaging in Barrett’s esophagus: a prospective randomized crossover study. Endoscopy 2005; 37: 929-936
      Artikel in Thieme ConnectPubMedGoogle Scholar
    • 15 Bajbouj M, Vieth M, Rösch T et al. Probe-based confocal laser endomicroscopy compared with standard four-quadrant biopsy for evaluation of neoplasia in Barrett’s esophagus. Endoscopy 2010; 42: 435-440
      Artikel in Thieme ConnectPubMedGoogle Scholar
    • 16 Sharma P, Meining AR, Coron E et al. Real-time increased detection of neoplastic tissue in Barrett’s esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2011; 74: 465-472
      CrossrefPubMedGoogle Scholar
    • 17 Horwhat JD, Maydonovitch CL, Ramos F et al. A randomized comparison of methylene blue-directed biopsy versus conventional four-quadrant biopsy for the detection of intestinal metaplasia and dysplasia in patients with long-segment Barrett’s esophagus. Am J Gastroenterol 2008; 103: 546-554
      CrossrefPubMedGoogle Scholar
    • 18 Curvers WL, Singh R, Song LM et al. Endoscopic tri-modal imaging for detection of early neoplasia in Barrett’s oesophagus: a multi-centre feasibility study using high-resolution endoscopy, autofluorescence imaging and narrow band imaging incorporated in one endoscopy system. Gut 2008; 57: 167-172
      CrossrefPubMedGoogle Scholar
    • 19 Kara MA, Peters FP, Fockens P et al. Endoscopic video-autofluorescence imaging followed by narrow band imaging for detecting early neoplasia in Barrett’s esophagus. Gastrointest Endosc 2006; 64: 176-185
      CrossrefPubMedGoogle Scholar
    • 20 Abrams JA, Kapel RC, Lindberg GM et al. Adherence to biopsy guidelines for Barrett’s esophagus surveillance in the community setting in the United States. Clin Gastroenterol Hepatol 2009; 7: 736-742
      CrossrefPubMedGoogle Scholar
    • 21 Spechler SJ, Sharma P et al. American Gastroenterological Association. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology 2011; 140: 1084-1091
      CrossrefPubMedGoogle Scholar
    • 22 Bhat S, Coleman HG, Yousef F et al. Risk of malignant progression in Barrett’s esophagus patients: results from a large population-based study. J Natl Cancer Inst 2011; 103: 1049-1057
      CrossrefPubMedGoogle Scholar
    • 23 Desai TK, Krishnan K, Samala N et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett’s oesophagus: a meta-analysis. Gut 2012; 61: 970-976
      CrossrefPubMedGoogle Scholar
    • 24 Hvid-Jensen F, Pedersen L, Drewes AM et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. NEJM 2011; 365: 1375-1383
      CrossrefPubMedGoogle Scholar
    • 25 Sturm MB, Joshi BP, Lu S et al. Targeted imaging of esophageal neoplasia with a fluorescently labeled peptide: first-in-human results. Sci Transl Med 2013; 5: 184ra61
      PubMedGoogle Scholar
    • 26 Otsu N. A threshold selection method from gray-level histograms. Automatica 1975; 11: 285-296
      CrossrefPubMedGoogle Scholar
    • 27 DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44: 837-845
      CrossrefPubMedGoogle Scholar
    • 28 Robin X, Turck N, Hainard A et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics 2011; 12: 77
      CrossrefPubMedGoogle Scholar
    • 29 Koopman PAR. Confidence intervals for the ratio of two binomial proportions. Biometrics 1984; 40: 513-517
      CrossrefPubMedGoogle Scholar
    • 30 Wolfsen HC, Crook JE, Krishna M et al. Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett’s Esophagus. Gastroenterology 2008; 135: 24-31
      CrossrefPubMedGoogle Scholar
    • 31 Sharma P, Hawes RH, Bansal A et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett’s oesophagus: a prospective, international, randomised controlled trial. Gut 2013; 62: 15-21
      CrossrefPubMedGoogle Scholar
    • 32 Thekkek N, Anandasabapathy S, Richards-Kortum R. Optical molecular imaging for detection of Barrett’s-associated neoplasia. World J Gastroenterol 2011; 17: 53-62
      CrossrefPubMedGoogle Scholar
    • 33 Curvers WL, Singh R, Song LM et al. Endoscopic tri-modal imaging for detection of early neoplasia in Barrett's oesophagus: a multi-centre feasibility study using high-resolution endoscopy, autofluorescence imaging and narrow band imaging incorporated in one endoscopy system. Gut 2008; 57: 167-172
      CrossrefPubMedGoogle Scholar
    • 34 Boerwinkel DF, Holz JA, Kara MA et al. Effects of autofluorescence imaging on detection and treatment of early neoplasia in patients with Barrett’s esophagus. Clin Gastroenterol Hepatol 2014; 12: 774-781
      CrossrefPubMedGoogle Scholar
    • 35 Bird-Lieberman EL, Neves AA, Lao-Sirieix P et al. Molecular imaging using fluorescent lectins permits rapid endoscopic identification of dysplasia in Barrett’s esophagus. Nat Med 2012; 18: 315-321
      CrossrefPubMedGoogle Scholar
    • 36 Tung CH, Mahmood U, Bredow S et al. In vivo imaging of proteolytic enzyme activity using a novel molecular reporter. Cancer Res 2000; 60: 4953-4958
      PubMedGoogle Scholar