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Dam AN, Lauwers GY. A new step for volumetric laser endomicroscopy: entering the therapeutic realm of endoscopic mucosal resection. Gastrointest Endosc 2019; 89:709-11. [PMID: 30902199 DOI: 10.1016/j.gie.2018.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/30/2018] [Indexed: 12/11/2022]
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Vasile MI, Mirea CS, Vîlcea ID, Obleaga CV, Câmpeanu R, Popescu M, Rogoveanu I, Cazacu S, Mogoantă SȘ, Moraru E. Update on Endoscopy-Based Imaging Techniques in the Diagnosis of Esophageal Cancer. Curr Health Sci J 2017; 43:295-300. [PMID: 30595892 DOI: 10.12865/CHSJ.43.04.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022]
Abstract
ABSTRACT: The early diagnosis of esophageal cancer is necessary for improving the surviving of patients with this disease. To ensure an accurate staging, there are necessary imaging tests to establish the local and regional extension, as well as excluding the metastases. Computed tomography (CT), endoscopic ultrasonography (EUS), and positron emission computed tomography (PET-CT) constitute standard methods for esophageal cancer staging. These techniques are complementary; using only one of these tests is not suitable for correct staging. The role of EUS has improved the doctors’ ability to evaluate and select the patients to undergo surgery, radiotherapy, or chemotherapy.
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Gora MJ, Suter MJ, Tearney GJ, Li X. Endoscopic optical coherence tomography: technologies and clinical applications [Invited]. Biomed Opt Express 2017; 8:2405-2444. [PMID: 28663882 PMCID: PMC5480489 DOI: 10.1364/boe.8.002405] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/20/2017] [Accepted: 03/27/2017] [Indexed: 05/07/2023]
Abstract
In this paper, we review the current state of technology development and clinical applications of endoscopic optical coherence tomography (OCT). Key design and engineering considerations are discussed for most OCT endoscopes, including side-viewing and forward-viewing probes, along with different scanning mechanisms (proximal-scanning versus distal-scanning). Multi-modal endoscopes that integrate OCT with other imaging modalities are also discussed. The review of clinical applications of endoscopic OCT focuses heavily on diagnosis of diseases and guidance of interventions. Representative applications in several organ systems are presented, such as in the cardiovascular, digestive, respiratory, and reproductive systems. A brief outlook of the field of endoscopic OCT is also discussed.
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Affiliation(s)
- Michalina J Gora
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- ICube Laboratory, CNRS, Strasbourg University, 1 Place de l'Hopital, Strasbourg 67091, France
| | - Melissa J Suter
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- Department of Medicine, Division of Pulmonary and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Xingde Li
- Department of Biomedical Engineering, Department of Electrical and Computer Engineering, and Department of Oncology, Johns Hopkins University, 720 Rutland Avenue, Traylor 710, Baltimore, MD 21205, USA
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Tsai TH, Zhou C, Tao YK, Lee HC, Ahsen OO, Figueiredo M, Kirtane T, Adler DC, Schmitt JM, Huang Q, Fujimoto JG, Mashimo H. Structural markers observed with endoscopic 3-dimensional optical coherence tomography correlating with Barrett's esophagus radiofrequency ablation treatment response (with videos). Gastrointest Endosc 2012; 76:1104-12. [PMID: 22831857 PMCID: PMC3485415 DOI: 10.1016/j.gie.2012.05.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/17/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is effective for treating Barrett's esophagus (BE) but often involves multiple endoscopy sessions over several months to achieve complete response. OBJECTIVE Identify structural markers that correlate with treatment response by using 3-dimensional (3-D) optical coherence tomography (OCT; 3-D OCT). DESIGN Cross-sectional. SETTING Single teaching hospital. PATIENTS Thirty-three patients, 32 male and 1 female, with short-segment (<3 cm) BE undergoing RFA treatment. INTERVENTION Patients were treated with focal RFA, and 3-D OCT was performed at the gastroesophageal junction before and immediately after the RFA treatment. Patients were re-examined with standard endoscopy 6 to 8 weeks later and had biopsies to rule out BE if not visibly evident. MAIN OUTCOME MEASUREMENTS The thickness of BE epithelium before RFA and the presence of residual gland-like structures immediately after RFA were determined by using 3-D OCT. The presence of BE at follow-up was assessed endoscopically. RESULTS BE mucosa was significantly thinner in patients who achieved complete eradication of intestinal metaplasia than in patients who did not achieve complete eradication of intestinal metaplasia at follow-up (257 ± 60 μm vs 403 ± 86 μm; P < .0001). A threshold thickness of 333 μm derived from receiver operating characteristic curves corresponded to a 92.3% sensitivity, 85% specificity, and 87.9% accuracy in predicting the presence of BE at follow-up. The presence of OCT-visible glands immediately after RFA also correlated with the presence of residual BE at follow-up (83.3% sensitivity, 95% specificity, 90.6% accuracy). LIMITATIONS Single center, cross-sectional study in which only patients with short-segment BE were examined. CONCLUSION Three-dimensional OCT assessment of BE thickness and residual glands during RFA sessions correlated with treatment response. Three-dimensional OCT may predict responses to RFA or aid in making real-time RFA retreatment decisions in the future.
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Affiliation(s)
- Tsung-Han Tsai
- Department of Electrical Engineering & Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Chao Zhou
- Department of Electrical Engineering & Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yuankai K. Tao
- Department of Electrical Engineering & Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Hsiang-Chieh Lee
- Department of Electrical Engineering & Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Osman O. Ahsen
- Department of Electrical Engineering & Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Marisa Figueiredo
- VA Healthcare System Boston, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Tejas Kirtane
- VA Healthcare System Boston, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Desmond C. Adler
- LightLab Imaging Inc. - St Jude Medical, Inc., Westford, MA, USA
| | | | - Qin Huang
- VA Healthcare System Boston, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - James G. Fujimoto
- Department of Electrical Engineering & Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Hiroshi Mashimo
- VA Healthcare System Boston, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Tsai TH, Zhou C, Lee HC, Tao YK, Ahsen OO, Figueiredo M, Adler DC, Schmitt JM, Huang Q, Fujimoto JG, Mashimo H. Comparison of Tissue Architectural Changes between Radiofrequency Ablation and Cryospray Ablation in Barrett's Esophagus Using Endoscopic Three-Dimensional Optical Coherence Tomography. Gastroenterol Res Pract 2012; 2012:684832. [PMID: 22844274 DOI: 10.1155/2012/684832] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 01/30/2023] Open
Abstract
Two main nonsurgical endoscopic approaches for ablating dysplastic and early cancer lesions in the esophagus have gained popularity, namely, radiofrequency ablation (RFA) and cryospray ablation (CSA). We report a uniquely suited endoscopic and near-microscopic imaging modality, three-dimensional (3D) optical coherence tomography (OCT), to assess and compare the esophagus immediately after RFA and CSA. The maximum depths of architectural changes were measured and compared between the two treatment groups. RFA was observed to induce 230~260 μm depth of architectural changes after each set of ablations over a particular region, while CSA was observed to induce edema-like spongiform changes to ~640 μm depth within the ablated field. The ability to obtain micron-scale depth-resolved images of tissue structural changes following different ablation therapies makes 3D-OCT an ideal tool to assess treatment efficacy. Such information could be potentially used to provide real-time feedback for treatment dosing and to identify regions that need further retreatment.
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Abstract
The emergence of endoscopy for the diagnosis of gastrointestinal diseases and the treatment of gastrointestinal diseases has brought great changes. The mere observation of anatomy with the imaging mode using modern endoscopy has played a significant role in this regard. However, increasing numbers of endoscopies have exposed additional deficiencies and defects such as anatomically similar diseases. Endoscopy can be used to examine lesions that are difficult to identify and diagnose. Early disease detection requires that substantive changes in biological function should be observed, but in the absence of marked morphological changes, endoscopic detection and diagnosis are difficult. Disease detection requires not only anatomic but also functional imaging to achieve a comprehensive interpretation and understanding. Therefore, we must ask if endoscopic examination can be integrated with both anatomic imaging and functional imaging. In recent years, as molecular biology and medical imaging technology have further developed, more functional imaging methods have emerged. This paper is a review of the literature related to endoscopic optical imaging methods in the hopes of initiating integration of functional imaging and anatomical imaging to yield a new and more effective type of endoscopy.
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Barwari K, de Bruin DM, Cauberg ECC, Faber DJ, van Leeuwen TG, Wijkstra H, de la Rosette J, Laguna MP. Advanced diagnostics in renal mass using optical coherence tomography: a preliminary report. J Endourol 2011; 25:311-5. [PMID: 21235359 DOI: 10.1089/end.2010.0408] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To avoid unnecessary surgical treatment of small renal masses (≤ 4 cm), a more accurate diagnostic method would be desirable since radiological differentiation between malignant and benign is difficult and nondiagnostic biopsies account from 9% to 37%. Optical coherence tomography (OCT) measures backscattered light versus depth, with an attenuation coefficient (μ(t)) that may vary among different histological types. We hypothesize that quantitative measurements of μ(t) using OCT can differentiate between normal renal parenchyma and renal cell carcinoma (RCC). MATERIALS AND METHODS Both normal and tumor renal tissues (RCC) were harvested after partial or radical nephrectomy. Analysis of μ(t) was based on difference of (1) μ(t) between normal and tumor tissue across all patients and (2) μ(t) between normal and tumor tissue within individual patients. RESULTS Tissue samples of 18 patients were measured, of which 4 were excluded (urothelial carcinoma, oncocytoma, and benign lesion without normal tissue available). Of the remaining 14 patients, 8 contributed with both normal and RCC tissue and 6 with only normal or RCC tissue. Independent observation showed a significant difference between the median μ(t) of normal renal tissue (4.95 mm⁻¹) and the median μ(t) of RCC (8.86 mm⁻¹). No statistically significant difference was found when comparing the difference in μ(t) between normal renal parenchyma and RCC within individual patients. CONCLUSION There is a significant difference in μ(t) between normal and RCC tissue across all patients. These results overpower the lack of significant difference within individuals, encouraging further research and suggesting a possible role for OCT in the diagnostic work-up of renal masses.
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Affiliation(s)
- Kurdo Barwari
- Department of Urology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Abstract
In recent years, significant clinical and technological advances have been made in endoscopic methods for diagnosis and treatment of early gastrointestinal neoplasms. However, essential information related to these novel techniques and their implications for practicing surgical pathologists have largely been missing in the general pathology literature. This article provides a general introduction to these novel therapeutic and diagnostic methods, and discusses their indications, contraindications, and potential limitations. The article aims to enable surgical pathologists to interact more efficiently with basic scientists and clinical colleagues to help implement and improve the existing clinical methods and to advance the new technologies.
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Affiliation(s)
- Gregory Y Lauwers
- Gastrointestinal Pathology Service, James Homer Wright Pathology Laboratories, 55 Fruit Street, WRN 219, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Kamran Badizadegan
- Gastrointestinal Pathology Service, James Homer Wright Pathology Laboratories, 55 Fruit Street, WRN 219, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
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Testoni PA, Mangiavillano B. Optical coherence tomography in detection of dysplasia and cancer of the gastrointestinal tract and bilio-pancreatic ductal system. World J Gastroenterol 2008; 14:6444-52. [PMID: 19030194 PMCID: PMC2773328 DOI: 10.3748/wjg.14.6444] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Optical coherence tomography (OCT) is an optical imaging modality that performs high-resolution, cross-sectional, subsurface tomographic imaging of the microstructure of tissues. The physical principle of OCT is similar to that of B-mode ultrasound imaging, except that it uses infrared light waves rather than acoustic waves. The in vivo resolution is 10-25 times better (about 10 μm) than with high-frequency ultrasound imaging, but the depth of penetration is limited to 1-3 mm, depending upon tissue structure, depth of focus of the probe used, and pressure applied to the tissue surface. In the last decade, OCT technology has evolved from an experimental laboratory tool to a new diagnostic imaging modality with a wide spectrum of clinical applications in medical practice, including the gastrointestinal (GI) tract and pancreatic-biliary ductal system. OCT imaging from the GI tract can be done in humans by using narrow-diameter, catheter-based probes that can be inserted through the accessory channel of either a conventional front-view endoscope, for investigating the epithelial structure of the GI tract, or a side-view endoscope, inside a standard transparent ERCP catheter, for investigating the pancreatico-biliary ductal system. Esophagus and the esophago-gastric junction has been the most widely investigated organ so far; more recently, also duodenum, colon and pancreatico-biliary ductal system have been extensively investigated. OCT imaging of the gastro-intestinal wall structure is characterized by a multiple-layer architecture that permits an accurate evaluation of the mucosa, lamina propria, muscularis mucosae, and part of the submucosa. The technique may be, therefore, used to identify pre-neoplastic conditions of the GI tract, such as Barrett's epithelium and dysplasia, and evaluate the depth of penetration of early-stage neoplastic lesions. OCT imaging of the pancreatic and biliary ductal system could improve the diagnostic accuracy for ductal epithelial changes and the differential diagnosis between neoplastic and non-neoplastic lesions.
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Seewald S, Ang TL, Groth S, Zhong Y, Bertschinger P, Altorfer J, Thonke F, Soehendra N. Detection and endoscopic therapy of early esophageal adenocarcinoma. Curr Opin Gastroenterol 2008; 24:521-9. [PMID: 18622170 DOI: 10.1097/MOG.0b013e3282ff8b1f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This review summarizes recent progress on endoscopic diagnosis and treatment of esophageal high-grade intraepithelial neoplasia and early adenocarcinoma and critically analyzes the literature in the context of preexisting scientific data. RECENT FINDINGS Narrow band imaging and computed virtual chromoendoscopy enhanced visualization of the mucosal morphology. The type of mucosal and capillary patterns seen on narrow band imaging predicted the presence of specialized intestinal metaplasia, high-grade intraepithelial neoplasia and early adenocarcinoma. Endocytoscopy lacked sufficient image quality for clinical use currently. Optical coherence tomography had the potential to diagnose specialized intestinal metaplasia and dysplasia. Photodynamic therapy produced long-term ablation of high-grade intraepithelial neoplasia and reduced cancer risk. Endoscopic radiofrequency ablation of Barrett's mucosa did not cause strictures and buried glandular mucosa. Localized and radical or complete circumferential endoscopic mucosal resections were effective and safe. SUMMARY Virtual chromoendoscopy detected subtle mucosal lesions and facilitated targeted biopsies. Photodynamic therapy was effective in the long term. Endoscopic radiofrequency ablation appeared promising. Localized and radical or complete circumferential endoscopic mucosa resections were effective therapies.
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Zagaynova E, Gladkova N, Shakhova N, Gelikonov G, Gelikonov V. Endoscopic OCT with forward-looking probe: clinical studies in urology and gastroenterology. J Biophotonics 2008; 1:114-28. [PMID: 19343643 DOI: 10.1002/jbio.200710017] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In the current paper we present results of application of endoscopic time-domain OCT (EOCT) with lateral scanning by forward looking miniprobe. We analysed material of clinical studies of 554 patients: 164 patients with urinary bladder pathology, and 390 with gastrointestinal tract pathology. We reviewed the materials obtained in different clinics using the OCT device elaborated at the Institute of Applied Physics. We demonstrate results of EOCT application in detection of early cancer and surgery guidance, examples of combined use of OCT and fluorescence imaging. As a result, we show the diagnostic accuracy of EOCT in specific clinical tasks. The sensitivity of EOCT cancer determination in Barrett's esophagus is from 71% to 85% at different stages of neoplasia with specificity 68% for all stages. As for bladder carcinoma, the sensitivity and specificity are 85% and 68%, respectively. In colon dysplasia EOST demonstrates high efficacy: sensitivity 92% and specificity 84%.
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Affiliation(s)
- E Zagaynova
- Institute of Applied and Fundamental Medicine, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia.
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Abstract
Columnar lined esophagus (CLE) or Barrett's esophagus is the precursor for esophageal adenocarcinoma. Future advances in understanding and management of this condition as well as improving the quality of care of CLE patients depends on answering essential questions. It is important to standardize the criteria for CLE definition. The rapid increase in incidence of CLE and adenocarcinoma raises serious concerns that the current management of gastroesophageal reflux disease (GERD) needs reassessment. The risk factors that determine who will and will not develop CLE are as yet undetermined. There is a need to develop a clinical risk stratification tool, which will help in determining who should be screened. The impact of elimination of GERD on the natural history of CLE is one important area for future research. The benefit of surveillance strategies remains unproven and the ideal endoscopic frequency, protocols and markers of cancer risk are unknown. Dysplasia may not provide the gold standard marker of cancer risk because of some inherited problems. A better technique than the current endoscopic pinch biopsy protocol is needed. To overcome the limitations of histological markers, many other markers of cancer risk needs to be developed and validated. The key question as to whether cancer risk is actually reduced by the new ablation modalities remains unanswered. The natural history of dysplasia and its management needs to be clarified. Although many questions have to be answered, it seems, however, that at least some answers exist, and these and proposals for answering some of these questions are underlined throughout this review.
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Affiliation(s)
- Kamal E Bani-Hani
- Department of Surgery, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
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Affiliation(s)
- Lawrence C Hookey
- Division of Gastroenterology, Hotel Dieu Hospital, Kingston, Canada.
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Qi X, Sivak MV, Isenberg G, Willis JE, Rollins AM. Computer-aided diagnosis of dysplasia in Barrett's esophagus using endoscopic optical coherence tomography. J Biomed Opt 2006; 11:044010. [PMID: 16965167 DOI: 10.1117/1.2337314] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Barrett's esophagus (BE) and associated adenocarcinoma have emerged as a major health care problem over the last two decades. Because of the widespread use of endoscopy, BE is being recognized increasingly in all Western countries. In clinical trials of endoscopic optical coherence tomography (EOCT), we defined certain image features that appear to be characteristic of precancerous (dysplastic) mucosa: decreased scattering and disorganization in the microscopic morphology. The objective of the present work is to develop computer-aided diagnosis (CAD) algorithms that aid the detection of dysplasia in BE. The image dataset used in the present study was derived from a total of 405 EOCT images (13 patients) that were paired with highly correlated histologic sections of corresponding biopsies. Of these, 106 images were included in the study. The CAD algorithm used was based on a standard texture analysis method (center-symmetric auto-correlation). Using histology as the reference standard, this CAD algorithm had a sensitivity of 82%, specificity of 74%, and accuracy of 83%. CAD has the potential to quantify and standardize the diagnosis of dysplasia and allows high throughput image evaluation for EOCT screening applications. With further refinements, CAD could also improve the accuracy of EOCT identification of dysplasia in BE.
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Affiliation(s)
- Xin Qi
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
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