ABSTRACT
Esophageal cancer is increasing in frequency in the United States faster than any other cancer. Barrett's esophagus, an otherwise benign complication of esophageal reflux, affects approximately three million Americans and precedes almost all cases of esophageal cancer. If detected as high-grade dysplasia (HGD), most esophageal cancers can be prevented. Standard-of-care screening for dysplasia uses visual endoscopy and a prescribed pattern of biopsy. This procedure, in which a tiny fraction of the affected tissue is selected for pathological examination, has a low probability of detection because dysplasia is highly focal and visually indistinguishable. We developed a system called endoscopic polarized scanning spectroscopy (EPSS), which performs rapid optical scanning and multispectral imaging of the entire esophageal surface and provides diagnoses in near real time. By detecting and mapping suspicious sites, guided biopsy of invisible, precancerous dysplasia becomes practicable. Here we report the development of EPSS and its application in several clinical cases, one of which merits special consideration.
Subject(s)
Barrett Esophagus/pathology , Esophageal Neoplasms/pathology , Esophagoscopy/methods , Esophagus/pathology , Gastroesophageal Reflux/pathology , Barrett Esophagus/complications , Biopsy/methods , Diagnostic Imaging/methods , Endoscopy/methods , Esophageal Neoplasms/complications , Gastroesophageal Reflux/complications , Humans , Hyperplasia/pathology , Spectrum Analysis/methodsABSTRACT
This letter reports the development of an endoscopic polarized scanning spectroscopy (EPSS) instrument compatible with existing endoscopes. This instrument uses light scattering spectroscopy (LSS). In proof-of-principle studies using a single-point instrument, LSS has successfully demonstrated the ability to identify pre-cancer in the epithelial tissues of five different organs, including Barrett's esophagus (BE). The EPSS instrument can provide real time in vivo information on the location of otherwise invisible high grade dysplasia (HGD), a predictor of adenocarcinoma, and thus can serve as a guide for biopsy. It should greatly reduce the time and labor involved in performing screening and obtaining diagnoses, cause less patient discomfort and ensure that fewer biopsies are required for the reliable location of pre-cancerous lesions.