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Marcazzan S, Braz Carvalho MJ, Nguyen NT, Strangmann J, Slotta-Huspenina J, Tenditnaya A, Tschurtschenthaler M, Rieder J, Proaño-Vasco A, Ntziachristos V, Steiger K, Gorpas D, Quante M, Kossatz S. PARP1-targeted fluorescence molecular endoscopy as novel tool for early detection of esophageal dysplasia and adenocarcinoma. J Exp Clin Cancer Res 2024; 43:53. [PMID: 38383387 PMCID: PMC10880256 DOI: 10.1186/s13046-024-02963-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Esophageal cancer is one of the 10 most common cancers worldwide and its incidence is dramatically increasing. Despite some improvements, the current surveillance protocol with white light endoscopy and random untargeted biopsies collection (Seattle protocol) fails to diagnose dysplastic and cancerous lesions in up to 50% of patients. Therefore, new endoscopic imaging technologies in combination with tumor-specific molecular probes are needed to improve early detection. Herein, we investigated the use of the fluorescent Poly (ADP-ribose) Polymerase 1 (PARP1)-inhibitor PARPi-FL for early detection of dysplastic lesions in patient-derived organoids and transgenic mouse models, which closely mimic the transformation from non-malignant Barrett's Esophagus (BE) to invasive esophageal adenocarcinoma (EAC). METHODS We determined PARP1 expression via immunohistochemistry (IHC) in human biospecimens and mouse tissues. We also assessed PARPi-FL uptake in patient- and mouse-derived organoids. Following intravenous injection of 75 nmol PARPi-FL/mouse in L2-IL1B (n = 4) and L2-IL1B/IL8Tg mice (n = 12), we conducted fluorescence molecular endoscopy (FME) and/or imaged whole excised stomachs to assess PARPi-FL accumulation in dysplastic lesions. L2-IL1B/IL8Tg mice (n = 3) and wild-type (WT) mice (n = 2) without PARPi-FL injection served as controls. The imaging results were validated by confocal microscopy and IHC of excised tissues. RESULTS IHC on patient and murine tissue revealed similar patterns of increasing PARP1 expression in presence of dysplasia and cancer. In human and murine organoids, PARPi-FL localized to PARP1-expressing epithelial cell nuclei after 10 min of incubation. Injection of PARPi-FL in transgenic mouse models of BE resulted in the successful detection of lesions via FME, with a mean target-to-background ratio > 2 independently from the disease stage. The localization of PARPi-FL in the lesions was confirmed by imaging of the excised stomachs and confocal microscopy. Without PARPi-FL injection, identification of lesions via FME in transgenic mice was not possible. CONCLUSION PARPi-FL imaging is a promising approach for clinically needed improved detection of dysplastic and malignant EAC lesions in patients with BE. Since PARPi-FL is currently evaluated in a phase 2 clinical trial for oral cancer detection after topical application, clinical translation for early detection of dysplasia and EAC in BE patients via FME screening appears feasible.
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Affiliation(s)
- Sabrina Marcazzan
- II. Medizinische Klinik, TUM School of Medicine and Health, Klinikum Rechts der Isar at Technical University of Munich, Munich, 81675, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany and Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), TUM School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany
- Clinical Radiology, Medical School OWL, Bielefeld University, Bielefeld, 33615, Germany
| | - Marcos J Braz Carvalho
- II. Medizinische Klinik, TUM School of Medicine and Health, Klinikum Rechts der Isar at Technical University of Munich, Munich, 81675, Germany
| | - Nghia T Nguyen
- Department of Nuclear Medicine, TUM School of Medicine and Health, Klinikum Rechts der Isar at Technical University of Munich, Munich, 81675, Germany
- Central Institute for Translational Cancer Research (TranslaTUM), TUM School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany
| | - Julia Strangmann
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany
| | - Julia Slotta-Huspenina
- Institute of Pathology, TUM School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany
| | - Anna Tenditnaya
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany and Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), TUM School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany
| | - Markus Tschurtschenthaler
- Central Institute for Translational Cancer Research (TranslaTUM), TUM School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany
- Division of Translational Cancer Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, 69120, Germany
- Chair of Translational Cancer Research and Institute of Experimental Cancer Therapy, TUM School of Medicine and Health, Klinikum rechts der Isar at Technical University of Munich, Munich, 81675, Germany
| | - Jonas Rieder
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany
| | - Andrea Proaño-Vasco
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany and Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), TUM School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany
| | - Katja Steiger
- Institute of Pathology, TUM School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany
- Comparative Experimental Pathology (CEP) and IBioTUM tissue biobank, TUM School of Medicine and Health, Technical University of Munich, München, 81675, Germany
| | - Dimitris Gorpas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany and Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), TUM School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany
| | - Michael Quante
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany.
| | - Susanne Kossatz
- Department of Nuclear Medicine, TUM School of Medicine and Health, Klinikum Rechts der Isar at Technical University of Munich, Munich, 81675, Germany.
- Central Institute for Translational Cancer Research (TranslaTUM), TUM School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany.
- Department of Chemistry, TUM School of Natural Sciences, Technical University of Munich, Munich, 85748, Germany.
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Kaur M, Menon C. Submillimeter Sized 2D Electrothermal Optical Fiber Scanner. SENSORS (BASEL, SWITZERLAND) 2022; 23:404. [PMID: 36617001 PMCID: PMC9823315 DOI: 10.3390/s23010404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Optical scanners are used frequently in medical imaging units to examine and diagnose cancers, assist with surgeries, and detect lesions and malignancies. The continuous growth in optics along with the use of optical fibers enables fabrication of imaging devices as small as a few millimeters in diameter. Most forward viewing endoscopic scanners contain an optical fiber acting as cantilever which is vibrated at resonance. In many cases, more than one actuating element is used to vibrate the optical fiber in two directions giving a 2D scan. In this paper, it is proposed to excite the cantilever fiber using a single actuator and scan a 2D region from its vibrating tip. An electrothermal actuator is optimized to provide a bidirectional (horizontal and vertical) displacement to the cantilever fiber placed on it. A periodic current, having a frequency equal to the resonant frequency of cantilever fiber, was passed through the actuator. The continuous expansion and contraction of the actuator enabled the free end of fiber to vibrate in a circle like pattern. A small change in the actuation frequency permitted the scanning of the area inside the circle.
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Affiliation(s)
- Mandeep Kaur
- MENRVA Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Surrey, BC V3T 0A3, Canada
| | - Carlo Menon
- MENRVA Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Surrey, BC V3T 0A3, Canada
- Department of Health Sciences and Technology, ETH Zürich, 8092 Zürich, Switzerland
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Can Chromoendoscopy Improve the Early Diagnosis of Gastric Carcinoma in Dogs? Animals (Basel) 2022; 12:ani12172253. [PMID: 36077972 PMCID: PMC9454935 DOI: 10.3390/ani12172253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Currently, canine gastric carcinoma is mainly diagnosed in its late, incurable phase, and strategies for early diagnosis are lacking. In human medicine, chromoendoscopic (CE) methods such as staining the gastric mucosal surface with indigo carmine (IC), and narrow band imaging (NBI), have improved the diagnosis of precancerous gastric mucosal changes and early gastric carcinoma. This study aimed at investigating whether IC-CE and NBI-CE can improve the diagnostic yield of endoscopy in dogs. Belgian Shepherd dogs are predisposed to gastric carcinoma; thus, 30 dogs of the breed served as the study population. As a result, the study revealed that especially the combination of standard white light endoscopy (WLE) with NBI-CE allows better recognition of gastric mucosal structural changes than WLE alone. However, CE assessment templates used to predict the type of mucosal change in humans were not applicable in dogs. The value of the study lies in providing evidence that CE can improve the diagnosis of precancerous changes and early gastric carcinoma in dogs. However, current image assessment templates from human medicine need major adjustments to comprehend canine gastric mucosal conditions. Abstract Chromoendoscopy has improved the early diagnosis of gastric cancer in humans but its usefulness in dogs is unknown. This study aimed at assessing whether adding narrow band imaging (NBI) or indigo carmine (IC) chromoendoscopy (CE) can improve the diagnostic yield of standard white light endoscopy (WLE). We compared the real-time findings of canine WLE, NBI-CE, and IC-CE and corresponding histology reports with endoscopic mucosal pattern assessment templates used in human medicine. Belgian Shepherd dogs are predisposed to gastric carcinoma. Therefore, 30 dogs of this breed served as the study population. According to histology, 17/30 dogs had mucosal changes (mucous metaplasia, glandular dysplasia, and gastric carcinoma). Diagnostic yield was best when targeted biopsies were taken with WLE and NBI-CE combined (15/17 cases). WLE alone positively identified only 8/17 cases and missed a gastric carcinoma in 3/6 cases. CE assessment templates based on macroscopic mucosal patterns, broadly used in human medicine, were not readily applicable in dogs. In conclusion, the study provides evidence that using CE in dogs has the potential to improve the diagnosis of precancerous gastric mucosal pathology and early gastric carcinoma. However, current image assessment templates from human medicine need major adjustments to the patterns of canine gastric mucosa.
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Alfonso-Garcia A, Cevallos SA, Lee JY, Li C, Bec J, Bäumler AJ, Marcu L. Assessment of Murine Colon Inflammation Using Intraluminal Fluorescence Lifetime Imaging. Molecules 2022; 27:1317. [PMID: 35209104 PMCID: PMC8875403 DOI: 10.3390/molecules27041317] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 01/22/2023] Open
Abstract
Inflammatory bowel disease (IBD) is typically diagnosed by exclusion years after its onset. Current diagnostic methods are indirect, destructive, or target overt disease. Screening strategies that can detect low-grade inflammation in the colon would improve patient prognosis and alleviate associated healthcare costs. Here, we test the feasibility of fluorescence lifetime imaging (FLIm) to detect inflammation from thick tissue in a non-destructive and label-free approach based on tissue autofluorescence. A pulse sampling FLIm instrument with 355 nm excitation was coupled to a rotating side-viewing endoscopic probe for high speed (10 mm/s) intraluminal imaging of the entire mucosal surface (50-80 mm) of freshly excised mice colons. Current results demonstrate that tissue autofluorescence lifetime was sensitive to the colon anatomy and the colonocyte layer. Moreover, mice under DSS-induced colitis and 5-ASA treatments showed changes in lifetime values that were qualitatively related to inflammatory markers consistent with alterations in epithelial bioenergetics (switch between β-oxidation and aerobic glycolysis) and physical structure (colon length). This study demonstrates the ability of intraluminal FLIm to image mucosal lifetime changes in response to inflammatory treatments and supports the development of FLIm as an in vivo imaging technique for monitoring the onset, progression, and treatment of inflammatory diseases.
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Affiliation(s)
- Alba Alfonso-Garcia
- Biomedical Engineering Department, University of California, Davis, CA 95616, USA; (C.L.); (J.B.); (L.M.)
| | - Stephanie A. Cevallos
- Medical Microbiology and Immunology Department, University of California, Davis, CA 95616, USA; (S.A.C.); (J.-Y.L.); (A.J.B.)
| | - Jee-Yon Lee
- Medical Microbiology and Immunology Department, University of California, Davis, CA 95616, USA; (S.A.C.); (J.-Y.L.); (A.J.B.)
| | - Cai Li
- Biomedical Engineering Department, University of California, Davis, CA 95616, USA; (C.L.); (J.B.); (L.M.)
| | - Julien Bec
- Biomedical Engineering Department, University of California, Davis, CA 95616, USA; (C.L.); (J.B.); (L.M.)
| | - Andreas J. Bäumler
- Medical Microbiology and Immunology Department, University of California, Davis, CA 95616, USA; (S.A.C.); (J.-Y.L.); (A.J.B.)
| | - Laura Marcu
- Biomedical Engineering Department, University of California, Davis, CA 95616, USA; (C.L.); (J.B.); (L.M.)
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Kaur M, Lane PM, Menon C. Scanning and Actuation Techniques for Cantilever-Based Fiber Optic Endoscopic Scanners-A Review. SENSORS 2021; 21:s21010251. [PMID: 33401728 PMCID: PMC7795415 DOI: 10.3390/s21010251] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 01/20/2023]
Abstract
Endoscopes are used routinely in modern medicine for in-vivo imaging of luminal organs. Technical advances in the micro-electro-mechanical system (MEMS) and optical fields have enabled the further miniaturization of endoscopes, resulting in the ability to image previously inaccessible small-caliber luminal organs, enabling the early detection of lesions and other abnormalities in these tissues. The development of scanning fiber endoscopes supports the fabrication of small cantilever-based imaging devices without compromising the image resolution. The size of an endoscope is highly dependent on the actuation and scanning method used to illuminate the target image area. Different actuation methods used in the design of small-sized cantilever-based endoscopes are reviewed in this paper along with their working principles, advantages and disadvantages, generated scanning patterns, and applications.
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Affiliation(s)
- Mandeep Kaur
- MENRVA Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Surrey, B.C. V3T 0A3, Canada;
- School of Engineering Science, Simon Fraser University, Burnaby, B.C. V5A 1S6, Canada;
- Imaging Unit, Integrative Oncology, BC Cancer Research Center, Vancouver, B.C., V5Z 1L3, Canada
| | - Pierre M. Lane
- School of Engineering Science, Simon Fraser University, Burnaby, B.C. V5A 1S6, Canada;
- Imaging Unit, Integrative Oncology, BC Cancer Research Center, Vancouver, B.C., V5Z 1L3, Canada
| | - Carlo Menon
- MENRVA Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Surrey, B.C. V3T 0A3, Canada;
- School of Engineering Science, Simon Fraser University, Burnaby, B.C. V5A 1S6, Canada;
- Correspondence:
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Development and Validation of Confocal Endomicroscopy Diagnostic Criteria for Low-Grade Dysplasia in Barrett's Esophagus. Clin Transl Gastroenterol 2020; 10:e00014. [PMID: 30985335 PMCID: PMC6602783 DOI: 10.14309/ctg.0000000000000014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Low-grade dysplasia (LGD) in Barrett's esophagus (BE) is generally inconspicuous on conventional and magnified endoscopy. Probe-based confocal laser endomicroscopy (pCLE) provides insight into gastro-intestinal mucosa at cellular resolution. We aimed to identify endomicroscopic features and develop pCLE diagnostic criteria for BE-related LGD.
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Iodine-Enhanced Micro-CT Imaging of Soft Tissue on the Example of Peripheral Nerve Regeneration. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:7483745. [PMID: 31049044 PMCID: PMC6458925 DOI: 10.1155/2019/7483745] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/25/2018] [Accepted: 01/22/2019] [Indexed: 02/06/2023]
Abstract
Microcomputed tomography (μCT) is widely used for the study of mineralized tissues, but a similar use for soft tissues is hindered by their low X-ray attenuation. This limitation can be overcome by the recent development of different staining techniques. Staining with Lugol's solution, a mixture of one part iodine and two parts potassium iodide in water, stands out among these techniques for its low complexity and cost. Currently, Lugol staining is mostly used for anatomical examination of tissues. In the present study, we seek to optimize the quality and reproducibility of the staining for ex vivo visualization of soft tissues in the context of a peripheral nerve regeneration model in the rat. We show that the staining result not only depends on the concentration of the staining solution but also on the amount of stain in relation to the tissue volume and composition, necessitating careful adaptation of the staining protocol to the respective specimen tissue. This optimization can be simplified by a stepwise staining which we show to yield a similar result compared to staining in a single step. Lugol staining solution results in concentration-dependent tissue shrinkage which can be minimized but not eliminated. We compared the shrinkage of tendon, nerve, skeletal muscle, heart, brain, and kidney with six iterations of Lugol staining. 60 ml of 0.3% Lugol's solution per cm3 of tissue for 24 h yielded good results on the example of a peripheral nerve regeneration model, and we were able to show that the regenerating nerve inside a silk fibroin tube can be visualized in 3D using this staining technique. This information helps in deciding the region of interest for histological imaging and provides a 3D context to histological findings. Correlating both imaging modalities has the potential to improve the understanding of the regenerative process.
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Li T, Hui H, Hu C, Ma H, Yang X, Tian J. Multiscale imaging of colitis in mice using confocal laser endomicroscopy, light-sheet fluorescence microscopy, and magnetic resonance imaging. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-8. [PMID: 30701723 PMCID: PMC6985686 DOI: 10.1117/1.jbo.24.1.016003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
The objective of our study is to develop a multimodality approach by combining magnetic resonance imaging (MRI) and optical imaging methods to assess acute murine colitis at the macro- and microscopic level. In vivo MRI is used to measure the cross-sectional areas of colons at the macroscopic level. Dual-color confocal laser endomicroscopy (CLE) allows in vivo examination of the fluorescently labeled epithelial cells and microvessels in the mucosa with a spatial resolution of ∼1.4 μm during ongoing endoscopy. To further validate the structural changes of the colons in three-dimensions, ex vivo light-sheet fluorescence microscopy (LSFM) is applied for in-toto imaging of cleared colon sections. MRI, LSFM, and CLE findings are significantly correlated with histological scoring (p < 0.01) and the inflammation-associated activity index (p < 0.01). Our multimodality imaging technique permits visualization of mucosa in colitis at different scales, which can enhance our understanding of the pathogenesis of inflammatory bowel diseases.
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Affiliation(s)
- Tianmeng Li
- Northeastern University, Sino-Dutch Biomedical and Information Engineering School, Shenyang, China
- Chinese Academy of Sciences, Institute of Automation, CAS Key Laboratory of Molecular Imaging, Beijing, China
- Institute of Automation, Beijing Key Laboratory of Molecular Imaging, Beijing, China
| | - Hui Hui
- Chinese Academy of Sciences, Institute of Automation, CAS Key Laboratory of Molecular Imaging, Beijing, China
- Institute of Automation, Beijing Key Laboratory of Molecular Imaging, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Chaoen Hu
- Chinese Academy of Sciences, Institute of Automation, CAS Key Laboratory of Molecular Imaging, Beijing, China
- Institute of Automation, Beijing Key Laboratory of Molecular Imaging, Beijing, China
| | - He Ma
- Northeastern University, Sino-Dutch Biomedical and Information Engineering School, Shenyang, China
| | - Xin Yang
- Chinese Academy of Sciences, Institute of Automation, CAS Key Laboratory of Molecular Imaging, Beijing, China
- Institute of Automation, Beijing Key Laboratory of Molecular Imaging, Beijing, China
| | - Jie Tian
- Chinese Academy of Sciences, Institute of Automation, CAS Key Laboratory of Molecular Imaging, Beijing, China
- Institute of Automation, Beijing Key Laboratory of Molecular Imaging, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
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Krishnamurthy S, Ban K, Shaw K, Mills G, Sheth R, Tam A, Gupta S, Sabir S. Confocal Fluorescence Microscopy Platform Suitable for Rapid Evaluation of Small Fragments of Tissue in Surgical Pathology Practice. Arch Pathol Lab Med 2018; 143:305-313. [PMID: 30376375 DOI: 10.5858/arpa.2018-0352-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Rapid advances in the fields of biophotonics, computer science, and instrumentation have allowed for high-resolution imaging of biologic tissues. OBJECTIVE.— To evaluate the quality of images from an optimized confocal fluorescence microscopy (CFM) platform for rapid evaluation of small fragments of tissue, compared with hematoxylin-eosin staining. DESIGN.— Tissue fragments (up to 1.0 × 0.3 cm) were stained with 0.6 mM acridine orange for 60 seconds and imaged using a CFM platform at 488-nm and 785-nm wavelength. The imaged tissues were then fixed in formalin and processed to generate hematoxylin-eosin-stained tissue sections. The quality of CFM images was scored on a scale of 0 to 3 on the basis of the percentage of the CFM images with recognizable tissue architecture (0, 0%; 1, <20%; 2, 20%-50%; 3, >50%). The diagnoses made using CFM images were compared with those made using histopathologic analysis of the hematoxylin-eosin-stained tissue sections. RESULTS.— We imaged 118 tissue fragments obtained from 40 breast, 23 lung, 39 kidney, and 16 liver surgical excision specimens. We acquired CFM images in 2 to 3 minutes; 95.8% (113 of 118) of images showed a quality score of 3, and 4.2% (5 of 118) had a score of 2. We achieved a sensitivity of 95.5%, specificity of 97.3%, positive predictive value of 95.5%, and negative predictive value of 97.3%. CONCLUSIONS.— Our results demonstrate the suitability of the CFM platform for rapid and accurate evaluation of small tissue fragments in surgical pathology practice.
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Affiliation(s)
- Savitri Krishnamurthy
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Kechen Ban
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Kenna Shaw
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Gordon Mills
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Rahul Sheth
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Alda Tam
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Sanjay Gupta
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Sharjeel Sabir
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
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Confocal laser microscopy as novel approach for real-time and in-vivo tissue examination during minimal-invasive surgery in colon cancer. Surg Endosc 2018; 33:1811-1817. [DOI: 10.1007/s00464-018-6457-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/18/2018] [Indexed: 01/01/2023]
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Hwang MJ, Kim KO, Kim AL, Lee SH, Jang BI, Kim TN. Histologic discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimens of colorectal polyp in actual clinical practice. Intest Res 2018; 16:475-483. [PMID: 30090047 PMCID: PMC6077297 DOI: 10.5217/ir.2018.16.3.475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/03/2018] [Accepted: 03/07/2018] [Indexed: 12/11/2022] Open
Abstract
Background/Aims We aimed to assess the rate of histologic discrepancy (HD) between endoscopic forceps biopsy (EFB) and totally resected specimens in colorectal polyp and analyze the risk factors of discordant group, especially under-diagnosis (UD) cases before complete removal of colorectal polyp. Methods From 2010 to 2015, a total of 290 polyps in 210 patients which had baseline pathology report before endoscopic resection (ER) were analyzed. UD cases were defined as those in which the diagnosis changed to a more advanced histologic feature after ER. Results A change in the final histology after ER was noted in 137 cases (47.2%), and after excluding 9 insignificant cases, 128 cases were further categorized into over-diagnosed and under-diagnosed group. UD occurred in 86 cases (29.7%) and change from benign to malignancy was noted in 26 cases (8.9%). On univariate analysis, a larger polyp size (>10 mm) was significantly associated with both HD (P<0.001) and UD (P<0.001). Regarding polyp morphology, protruding or flat was not significantly important. On multivariate analysis, polyp size >10 mm was the single most significant predictor of both HD (P<0.001) and UD (P<0.001). Conclusions The HD and UD rates were 47.2% and 29.7%, respectively. Polyp size >10 mm was the most important predictor of both HD and UD. We should be careful in making treatment strategy of colorectal polyp based on histologic report of EFB especially when the size of polyp is >10 mm.
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Affiliation(s)
- Moon Joo Hwang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyeong Ok Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - A Lim Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Si Hyung Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Byung Ik Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Tae Nyeun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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12
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Use of confocal laser endomicroscopy with a fluorescently labeled fatty acid to diagnose colorectal neoplasms. Oncotarget 2017; 8:58934-58947. [PMID: 28938608 PMCID: PMC5601704 DOI: 10.18632/oncotarget.19515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/11/2017] [Indexed: 01/14/2023] Open
Abstract
Endoscopic treatment for early colorectal cancer closely correlates with patient prognosis. However, endoscopic differentiation between carcinomas and non-neoplastic lesions remains difficult. Here, we topically stained colorectal neoplasms with a fatty acid analogue (BODIPY-FA) and quantified the fluorescent signals using confocal laser endomicroscopy (CLE) and fluorescence microscopy. We also analyzed protein expression in colorectal cancer tissues. We found that expression of fatty acid synthase was elevated, while the expression of fatty acid transporters was reduced in colorectal cancer. In colorectal cancer mouse models and patients, the BODIPY-FA signals were higher in normal epithelia than in carcinomas or colonic intraepithelial neoplasias. BODIPY-FA staining revealed both the arrangement of intestinal glands and the intracellular structures under CLE screening. In a double-blind trial, CLE images stained with BODIPY-FA exhibited greater consistency (κ = 0.68) and overall validity (74.65%) than those stained using intravenous fluorescein sodium (κ = 0.43, 55.88%) when the results were compared with histological diagnoses. These findings suggest that topical use of BODIPY-FA with CLE is a promising imaging approach for early colorectal neoplasm screening.
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13
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Hannouf MB, Winquist E, Mahmud SM, Brackstone M, Sarma S, Rodrigues G, Rogan PK, Hoch JS, Zaric GS. The Clinical Significance of Occult Gastrointestinal Primary Tumours in Metastatic Cancer: A Population Retrospective Cohort Study. Cancer Res Treat 2017; 50:183-194. [PMID: 28324922 PMCID: PMC5784645 DOI: 10.4143/crt.2016.532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/16/2017] [Indexed: 01/10/2023] Open
Abstract
Purpose The purpose of this study was to estimate the incidence of occult gastrointestinal (GI) primary tumours in patients with metastatic cancer of uncertain primary origin and evaluate their influence on treatments and overall survival (OS). Materials and Methods We used population heath data from Manitoba, Canada to identify all patients initially diagnosed with metastatic cancer between 2002 and 2011. We defined patients to have “occult” primary tumour if the primary was found at least 6 months after initial diagnosis. Otherwise, we considered primary tumours as “obvious.” We used propensity-score methods to match each patient with occult GI tumour to four patients with obvious GI tumour on all known clinicopathologic features. We compared treatments and 2-year survival data between the two patient groups and assessed treatment effect on OS using Cox regression adjustment. Results Eighty-three patients had occult GI primary tumours, accounting for 17.6% of men and 14% of women with metastatic cancer of uncertain primary. A 1:4 matching created a matched group of 332 patients with obvious GI primary tumour. Occult cases compared to the matched group were less likely to receive surgical interventions and targeted biological therapy, and more likely to receive cytotoxic empiric chemotherapeutic agents. Having an occult GI tumour was associated with reduced OS and appeared to be a nonsignificant independent predictor of OS when adjusting for treatment differences. Conclusion GI tumours are the most common occult primary tumours in men and the second most common in women. Patients with occult GI primary tumours are potentially being undertreated with available GI site-specific and targeted therapies.
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Affiliation(s)
- Malek B Hannouf
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Ivey Business School, Western University, London, ON, Canada
| | - Eric Winquist
- Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Salaheddin M Mahmud
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Muriel Brackstone
- Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - George Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Peter K Rogan
- Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jeffrey S Hoch
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Gregory S Zaric
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Ivey Business School, Western University, London, ON, Canada
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14
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Ellebrecht DB, Gebhard MPE, Horn M, Keck T, Kleemann M. Laparoscopic Confocal Laser Microscopy Without Fluorescent Injection. Surg Innov 2016; 23:341-6. [DOI: 10.1177/1553350616637690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. Histological analysis of surgical specimen is the gold standard for cancer classification. In particular, frozen histological diagnosis of vague peritoneal spots or uncertain excision of tumors plays a crucial role for proceeding with or without change of the operation procedure. Confocal laser microscopy (CLM) enables in vivo and real-time high-resolution tissue analysis. To evaluate a novel technique of CLM without any fluorescent dye, this pilot ex vivo study demonstrates a CLM camera device for minimal invasive surgical approach. Methods. In 5 cases, a laparoscopic CLM camera was used for examining colon and rectum specimen. Images of nonmalignant and malignant intestinal mucosa were characterized in terms of specific signal-patterns. No fluorescent dye was used. Correlations to findings in conventional histology were systematically recorded and described. Results. Using this CLM camera device, it is possible to analyze colon specimen mucosa. Nonmalignant and malignant intestinal mucosa show specific signal patterns. Nonmalignant mucosa is defined by honeycomb structure. There is deregulated structure in colon and rectum carcinoma mucosa. The inside lumen is irregular. The radial border appears swollen with reduced contrast. Discussion. This pilot study shows that the assessment of colon mucosa with a prototype of CLM camera for minimally invasive surgical approach without any fluorescent dye is feasible. It is possible to differentiate between benign and malignant mucosa in colon specimen by easy to evaluate and reproducible parameters. These first steps of this pioneering achievement to establish CLM in minimal invasive surgical procedures show a great potential for a more reliable intraoperative evaluation of suspect foci.
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Affiliation(s)
- David B. Ellebrecht
- University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Marco Horn
- University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Tobias Keck
- University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Markus Kleemann
- University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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15
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Li J, Liu F, Gupta S, Li C. Interventional Nanotheranostics of Pancreatic Ductal Adenocarcinoma. Am J Cancer Res 2016; 6:1393-402. [PMID: 27375787 PMCID: PMC4924507 DOI: 10.7150/thno.15122] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/19/2016] [Indexed: 12/13/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) accounts for over 90% of all pancreatic cancer. Nanoparticles (NPs) offer new opportunities for image-guided therapy owing to the unique physicochemical properties of the nanoscale effect and the multifunctional capabilities of NPs. However, major obstacles exist for NP-mediated cancer theranostics, especially in PDAC. The hypovascular nature of PDAC may impede the deposition of NPs into the tumor after systemic administration, and most NPs localize predominantly in the mononuclear phagocytic system, leading to a relatively poor tumor-to-surrounding-organ uptake ratio. Image guidance combined with minimally invasive interventional procedures may help circumvent these barriers to poor drug delivery of NPs in PDAC. Interventional treatments allow regional drug delivery, targeted vascular embolization, direct tumor ablation, and the possibility of disrupting the stromal barrier of PDAC. Interventional treatments also have potentially fewer complications, faster recovery, and lower cost compared with conventional therapies. This work is an overview of current image-guided interventional cancer nanotheranostics with specific attention given to their applications for the management of PDAC.
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16
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Tontini GE, Rath T, Neumann H. Advanced gastrointestinal endoscopic imaging for inflammatory bowel diseases. World J Gastroenterol 2016; 22:1246-1259. [PMID: 26811662 PMCID: PMC4716035 DOI: 10.3748/wjg.v22.i3.1246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/15/2015] [Accepted: 11/09/2015] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal luminal endoscopy is of paramount importance for diagnosis, monitoring and dysplasia surveillance in patients with both, Crohn’s disease and ulcerative colitis. Moreover, with the recent recognition that mucosal healing is directly linked to the clinical outcome of patients with inflammatory bowel disorders, a growing demand exists for the precise, timely and detailed endoscopic assessment of superficial mucosal layer. Further, the novel field of molecular imaging has tremendously expanded the clinical utility and applications of modern endoscopy, now encompassing not only diagnosis, surveillance, and treatment but also the prediction of individual therapeutic responses. Within this review, we describe how novel endoscopic approaches and advanced endoscopic imaging methods such as high definition and high magnification endoscopy, dye-based and dye-less chromoendoscopy, confocal laser endomicroscopy, endocytoscopy and molecular imaging now allow for the precise and ultrastructural assessment of mucosal inflammation and describe the potential of these techniques for dysplasia detection.
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17
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Dutta AK, Chacko A. Emerging role of narrow band imaging in duodenum. World J Gastrointest Endosc 2015; 7:1216-1221. [PMID: 26566428 PMCID: PMC4639743 DOI: 10.4253/wjge.v7.i16.1216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/20/2015] [Accepted: 09/30/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopy using magnification narrow band imaging (mNBI) allows detailed assessment of mucosal surface and vascular pattern. This may help in better identification and prediction of the nature of the lesion. The role of this technology in duodenum is still evolving. Studies have shown that mNBI has high accuracy in predicting villous atrophy in the duodenum. Limited data suggests that this technique can provide additional information on duodenal polyps, nodules and ampullary tumour which can help guide their management. In this paper we describe the technique for duodenal assessment using NBI and review the existing literature evaluating its role in diagnosis of various duodenal pathologies.
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18
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Dochow S, Ma D, Latka I, Bocklitz T, Hartl B, Bec J, Fatakdawala H, Marple E, Urmey K, Wachsmann-Hogiu S, Schmitt M, Marcu L, Popp J. Combined fiber probe for fluorescence lifetime and Raman spectroscopy. Anal Bioanal Chem 2015; 407:8291-301. [PMID: 26093843 PMCID: PMC4995092 DOI: 10.1007/s00216-015-8800-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 12/23/2022]
Abstract
In this contribution we present a dual modality fiber optic probe combining fluorescence lifetime imaging (FLIm) and Raman spectroscopy for in vivo endoscopic applications. The presented multi-spectroscopy probe enables efficient excitation and collection of fluorescence lifetime signals for FLIm in the UV/visible wavelength region, as well as of Raman spectra in the near-IR for simultaneous Raman/FLIm imaging. The probe was characterized in terms of its lateral resolution and distance dependency of the Raman and FLIm signals. In addition, the feasibility of the probe for in vivo FLIm and Raman spectral characterization of tissue was demonstrated. Graphical Abstract An image comparison between FLIm and Raman spectroscopy acquired with the bimodal probe onseveral tissue samples.
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Affiliation(s)
- Sebastian Dochow
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany
| | - Dinglong Ma
- Department of Biomedical Engineering, University of California, Davis, 451 E. Health Sciences Drive, Davis, CA, 95616, USA
| | - Ines Latka
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany
| | - Thomas Bocklitz
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany
| | - Brad Hartl
- Department of Biomedical Engineering, University of California, Davis, 451 E. Health Sciences Drive, Davis, CA, 95616, USA
| | - Julien Bec
- Department of Biomedical Engineering, University of California, Davis, 451 E. Health Sciences Drive, Davis, CA, 95616, USA
| | - Hussain Fatakdawala
- Department of Biomedical Engineering, University of California, Davis, 451 E. Health Sciences Drive, Davis, CA, 95616, USA
| | - Eric Marple
- EmVision LCC, 1471 F Road, Loxahatchee, FL, 33470, USA
| | - Kirk Urmey
- EmVision LCC, 1471 F Road, Loxahatchee, FL, 33470, USA
| | - Sebastian Wachsmann-Hogiu
- Department of Pathology and Laboratory Medicine and Center for Biophotonics, University of California, Davis, 2700 Stockton Blvd., Sacramento, CA, 95817, USA
| | - Michael Schmitt
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, 451 E. Health Sciences Drive, Davis, CA, 95616, USA.
| | - Jürgen Popp
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany.
- Leibniz Institute of Photonic Technology Jena e.V., Albert-Einstein-Str. 9, 07745, Jena, Germany.
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19
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di Pietro M, Bird-Lieberman EL, Liu X, Nuckcheddy-Grant T, Bertani H, O'Donovan M, Fitzgerald RC. Autofluorescence-Directed Confocal Endomicroscopy in Combination With a Three-Biomarker Panel Can Inform Management Decisions in Barrett's Esophagus. Am J Gastroenterol 2015; 110:1549-58. [PMID: 26416188 DOI: 10.1038/ajg.2015.295] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 07/16/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Barrett's esophagus (BE) surveillance with white-light endoscopy and quadrantic biopsies (Seattle protocol) is resource intensive and limited by sampling error. Previous work suggests that autofluorescence imaging (AFI) in combination with a molecular panel might reduce the number of biopsies, but this was not sufficiently sensitive for low-grade dysplasia, now a point for endoscopic intervention. Here we used AFI to direct narrow-field imaging tools for real-time optical assessment of dysplasia and biopsies for a biomarker panel. We compared the new diagnostic algorithm with the current standard. METHODS A total of 55 patients with BE were recruited at a single tertiary referral center. Patients underwent high-resolution endoscopy followed by AFI. AFI-targeted areas (n=194) were examined in turn by narrow-band imaging with magnification (NBIz) and probe-based confocal laser endomicroscopy (pCLE). Biopsies were taken from AFI-targeted areas and tested using an established molecular panel comprising aneuploidy plus cyclin A and p53 immunohistochemistry. RESULTS In the per-patient analysis the overall sensitivity and specificity of AFI-targeted pCLE were 100% and 53.6% for high-grade dysplasia/intramucosal cancer and 96.4% and 74.1% for any grade of dysplasia, respectively. NBIz had equal specificity for dysplasia detection (74.1%), but significantly lower sensitivity (57.1%) than pCLE. The time required to perform AFI-targeted pCLE was shorter that that taken by the Seattle protocol (P=0.0004). We found enrichment of molecular abnormalities in areas with optical dysplasia by pCLE (P<0.001), regardless of histologic dysplasia. The addition of the 3-biomarker panel reduced the false positive rate of pCLE by 50%, leading to sensitivity and specificity for any grade of dysplasia of 89.2% and 88.9%, respectively. CONCLUSIONS The combination of pCLE on AFI-targeted areas and a 3-biomarker panel identifies patients with dysplasia.
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Affiliation(s)
| | - Elizabeth L Bird-Lieberman
- MRC Cancer Unit, University of Cambridge, Cambridge, UK.,Translational Gastroenterology Unit, Experimental Medicine Division, John Radcliffe Hospital, Oxford, UK
| | - Xinxue Liu
- MRC Cancer Unit, University of Cambridge, Cambridge, UK
| | | | - Helga Bertani
- Department of Digestive Endoscopy, Nuovo Ospedale Civile S. Agostino, Modena, Italy
| | - Maria O'Donovan
- Department of Histopathology, Cambridge University Hospitals, Cambridge, UK
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20
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Rath T, Tontini GE, Neurath MF, Neumann H. From the surface to the single cell: Novel endoscopic approaches in inflammatory bowel disease. World J Gastroenterol 2015; 21:11260-11272. [PMID: 26523101 PMCID: PMC4616203 DOI: 10.3748/wjg.v21.i40.11260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/31/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBD) comprise the two major entities Crohn’s disease and ulcerative colitis and endoscopic imaging of the gastrointestinal tract has always been an integral and central part in the management of IBD patients. Within the recent years, mucosal healing emerged as a key treatment goal in IBD that substantially decides about the clinical outcome of IBD patients, thereby demanding for a precise, timely and detailed endoscopic assessment of the mucosal inflammation associated with IBD. Further, molecular imaging has tremendously expanded the clinical utility and applications of modern endoscopy, now encompassing not only diagnosis, surveillance, and treatment but also the prediction of individual therapy response. Within this review we describe novel endoscopic approaches and advanced endoscopic imaging methods for the diagnosis, treatment and surveillance of IBD patients. We begin by providing an overview over novel and advanced imaging techniques such as magnification endoscopy and dye-based and dye-less chromoendoscopy, endomicroscopy and endocytoscopy. We then describe how these techniques can be utilized for the precise and ultrastructural assessment of mucosal inflammation and dysplasia development associated with IBD and outline how they have enabled the endoscopist to gain insight onto the cellular level in real-time. Finally, we provide an outlook on how molecular imaging has rapidly evolved in the recent past and can be used to make individual predictions about the therapeutic response towards biological treatment.
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21
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Coda S, Siersema PD, Stamp GWH, Thillainayagam AV. Biophotonic endoscopy: a review of clinical research techniques for optical imaging and sensing of early gastrointestinal cancer. Endosc Int Open 2015; 3:E380-92. [PMID: 26528489 PMCID: PMC4612244 DOI: 10.1055/s-0034-1392513] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 05/07/2015] [Indexed: 02/08/2023] Open
Abstract
Detection, characterization, and staging constitute the fundamental elements in the endoscopic diagnosis of gastrointestinal diseases, but histology still remains the diagnostic gold standard. New developments in endoscopic techniques may challenge histopathology in the near future. An ideal endoscopic technique should combine a wide-field, "red flag" screening technique with an optical contrast or microscopy method for characterization and staging, all simultaneously available during the procedure. In theory, biophotonic advances have the potential to unite these elements to allow in vivo "optical biopsy." These techniques may ultimately offer the potential to increase the rates of detection of high risk lesions and the ability to target biopsies and resections, and so reduce the need for biopsy, costs, and uncertainty for patients. However, their utility and sensitivity in clinical practice must be evaluated against those of conventional histopathology. This review describes some of the most recent applications of biophotonics in endoscopic optical imaging and metrology, along with their fundamental principles and the clinical experience that has been acquired in their deployment as tools for the endoscopist. Particular emphasis has been placed on translational label-free optical techniques, such as fluorescence spectroscopy, fluorescence lifetime imaging microscopy (FLIM), two-photon and multi-photon microscopy, second harmonic generation (SHG) and third harmonic generation (THG) imaging, optical coherence tomography (OCT), diffuse reflectance, Raman spectroscopy, and molecular imaging.
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Affiliation(s)
- Sergio Coda
- Section of Gastroenterology and Hepatology, Department of Medicine, Imperial College London, London, United Kingdom,Photonics Group, Department of Physics, Imperial College London, London, United Kingdom,Endoscopy Unit, Department of Gastroenterology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom,Department of Endoscopy, North East London NHS Treatment Centre, Care UK, London, United Kingdom,Corresponding author Sergio Coda, MD, PhD Imperial College London – Medicine and PhysicsPrince Consort RoadLondon SW7 2AZUnited Kingdom+44-20-75947714
| | - Peter D. Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gordon W. H. Stamp
- Photonics Group, Department of Physics, Imperial College London, London, United Kingdom,Experimental Histopathology Laboratory, Cancer Research UK London Research Institute, London, United Kingdom,Department of Histopathology, Imperial College London, London, United Kingdom
| | - Andrew V. Thillainayagam
- Section of Gastroenterology and Hepatology, Department of Medicine, Imperial College London, London, United Kingdom,Photonics Group, Department of Physics, Imperial College London, London, United Kingdom,Endoscopy Unit, Department of Gastroenterology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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22
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Hopkins TM, Heilman AM, Liggett JA, LaSance K, Little KJ, Hom DB, Minteer DM, Marra KG, Pixley SK. Combining micro-computed tomography with histology to analyze biomedical implants for peripheral nerve repair. J Neurosci Methods 2015; 255:122-30. [PMID: 26300184 DOI: 10.1016/j.jneumeth.2015.08.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/16/2015] [Accepted: 08/12/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Biomedical implants used in tissue engineering repairs, such as scaffolds to repair peripheral nerves, can be too large to examine completely with histological analyses. Micro-computed tomography (micro-CT) with contrast agents allows ex vivo visualization of entire biomaterial implants and their interactions with tissues, but contrast agents can interfere with histological analyses of the tissues or cause shrinkage or loss of antigenicity. NEW METHOD Soft tissue, ex vivo micro-CT imaging using Lugol's iodine was compatible with histology after using a rapid (48 h) method of removing iodine. RESULTS Adult normal and repaired rat sciatic nerves were infiltrated ex vivo with iodine, imaged with micro-CT and then the iodine was removed by incubating tissues in sodium thiosulfate. Subsequent paraffin sections of normal nerve tissues showed no differences in staining with hematoxylin and eosin or immunostaining with multiple antibodies. Iodine treatment and removal did not alter axonal diameter, nuclear size or relative area covered by immunostained axons (p>0.05). Combining imaging modalities allowed comparisons of macroscopic and microscopic features of nerve tissues regenerating through simple nerve conduits or nerve conduits containing a titanium wire for guidance. COMPARISON WITH EXISTING METHODS Quantification showed that treatment with iodine and sodium thiosulfate did not result in tissue shrinkage or loss of antigenicity. CONCLUSIONS Because this combination of treatments is rapid and does not alter tissue morphology, this expands the ex vivo methods available to examine the success of biomaterial implants used for tissue engineering repairs.
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Affiliation(s)
- Tracy M Hopkins
- Department of Molecular and Cellular Physiology, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Alexander M Heilman
- Department of Molecular and Cellular Physiology, University of Cincinnati College of Medicine, Cincinnati, United States
| | - James A Liggett
- Department of Molecular and Cellular Physiology, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Kathleen LaSance
- Vontz Core Imaging Lab (VCIL), University of Cincinnati College of Medicine, Cincinnati, United States
| | - Kevin J Little
- Division of Pediatric Orthopaedics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - David B Hom
- Division of Facial Plastic & Reconstructive Surgery, Program Director for the Facial Paralysis Clinic, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Danielle M Minteer
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States
| | - Kacey G Marra
- Departments of Plastic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, United States; Plastic Surgery Research Laboratory, Faculty, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, United States
| | - Sarah K Pixley
- Department of Molecular and Cellular Physiology, University of Cincinnati College of Medicine, Cincinnati, United States.
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23
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Van Gossum A. Image-enhanced capsule endoscopy for characterization of small bowel lesions. Best Pract Res Clin Gastroenterol 2015; 29:525-31. [PMID: 26381299 DOI: 10.1016/j.bpg.2015.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 01/31/2023]
Abstract
Video capsule endoscopy has revolutionized direct endoscopic imaging of the gut. Small-bowel video capsule endoscopy (SBVCE) is now the first-line procedure for exploring the small bowel in case of obscure digestive bleeding and has also some room in case of Crohn's disease, coeliac disease and polyposis syndrome. In case of obscure digestive bleeding the main lesions are angioectasias, erosions/ulcerations and tumors. As for conventional optical endoscopy search was done for improving the detection and characterization of small-bowel lesions. The Fujinon Intelligent Chromoendoscopy (FICE) has been adapted on the software of the SBVCE (Given Imaging(®)/Medtronics). Although there are some conflicting results on the efficacy of FICE for detecting more lesions than with conventional light, it is now recognized that FICE - particularly the setting 1 - may enhance the delineation or characterization of lesions. The use of three-dimensional representation technique is now feasible but still needs further research.
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Affiliation(s)
- André Van Gossum
- Department of Gastroenterology and Hepatology, Hôpital Erasme, Free University of Brussels, Brussels, Belgium.
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González-Fernández C, Barreto-Zúñiga R, Grajales-Figueroa G, Martínez Lozano JA. Endomicroscopia láser confocal con sonda en pacientes con esófago de Barrett. ENDOSCOPIA 2015. [DOI: 10.1016/j.endomx.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mielke L, Preaudet A, Belz G, Putoczki T. Confocal laser endomicroscopy to monitor the colonic mucosa of mice. J Immunol Methods 2015; 421:81-88. [PMID: 25960174 PMCID: PMC5803490 DOI: 10.1016/j.jim.2015.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/27/2015] [Accepted: 04/15/2015] [Indexed: 12/13/2022]
Abstract
The gastrointestinal tract is a unique organ system that provides an epithelial barrier between our underlying immune system and luminal pathogens. Disruption of gastrointestinal homeostasis, as a result of impaired barrier function, is associated with numerous pathologies including inflammatory bowel disease and colorectal cancer. In parallel to the clinical development of endoscopy technologies to monitor and diagnose these pathologies in humans, advanced mouse colonoscopy techniques are being developed. When these technologies are coupled with model systems of human disease, which are essential to our understanding of the pathophysiology of gastrointestinal diseases, the requirement for euthanasia of multiple cohorts of mice is eliminated. Here we highlight the suitability of white light endoscopy to monitor the progression of colitis in mice. We further outline the experimental power of combined standard endoscopy with confocal microendoscopy, which permits visualization of fluorescent markers in a single animal in real-time. Together, these technologies will enhance our understanding of the interplay between components of the gastrointestinal microenvironment and their role in disease. Monitoring of mucosal damage using white light endoscopy Monitoring of the epithelial barrier using confocal endomicroscopy Monitoring of the vasculature architecture using confocal endomicroscopy
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Affiliation(s)
- Lisa Mielke
- The Walter and Eliza Hall Institute for Medical Research, Melbourne, Australia; The Department of Medical Biology, University of Melbourne, Australia
| | - Adele Preaudet
- The Walter and Eliza Hall Institute for Medical Research, Melbourne, Australia
| | - Gabrielle Belz
- The Walter and Eliza Hall Institute for Medical Research, Melbourne, Australia; The Department of Medical Biology, University of Melbourne, Australia
| | - Tracy Putoczki
- The Walter and Eliza Hall Institute for Medical Research, Melbourne, Australia; The Department of Medical Biology, University of Melbourne, Australia.
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Abstract
Although removal of adenomatous polyps has been shown to decrease the risk of colon cancer, distal hyperplastic polyps are thought to not have malignant potential. Most polyps detected during colonoscopy are diminutive (≤ 5 mm) and rarely harbor advanced histology, such as high-grade dysplasia or cancer. Therefore, predicting histology in real-time during colonoscopy can potentially decrease the enormous expenditure that ensues from universal histopathologic evaluation of polyps, and several novel imaging technologies have been developed and tested over the past decade for this purpose. Of these different technologies, electronic chromoendoscopy seems to strike a fair balance between accuracy, feasibility, and cost.
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Affiliation(s)
- Shreyas Saligram
- University of Kansas School of Medicine, University of Kansas, Department of Gastroenterology, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Veterans Affairs Medical Center, Department of Gastroenterology, 4801 Linwood Blvd, Kansas City, MO 64128, USA
| | - Amit Rastogi
- University of Kansas School of Medicine, University of Kansas, Department of Gastroenterology, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Veterans Affairs Medical Center, Department of Gastroenterology, 4801 Linwood Blvd, Kansas City, MO 64128, USA.
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Jang HY, Hong SJ, Han JP, Park SK, Yun HK, Ko BJ. Comparison of the Diagnostic Usefulness of Conventional Magnification and Near-focus Methods with Narrow-band Imaging for Gastric Epithelial Tumors. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2015. [DOI: 10.7704/kjhugr.2015.15.1.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hee Yoon Jang
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Su Jin Hong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Pil Han
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Se Kyung Park
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Han Kyeol Yun
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bong Jin Ko
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
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