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Multispectral scanning during endoscopy guides biopsy of dysplasia in Barrett's esophagus

Nature Medicine volume 16, pages 603–606 (2010)Cite this article

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Abstract

Esophageal cancer is increasing in frequency in the United States faster than any other cancer. Barrett's esophagus, an otherwise benign complication of esophageal reflux, affects approximately three million Americans and precedes almost all cases of esophageal cancer. If detected as high-grade dysplasia (HGD), most esophageal cancers can be prevented. Standard-of-care screening for dysplasia uses visual endoscopy and a prescribed pattern of biopsy. This procedure, in which a tiny fraction of the affected tissue is selected for pathological examination, has a low probability of detection because dysplasia is highly focal and visually indistinguishable. We developed a system called endoscopic polarized scanning spectroscopy (EPSS), which performs rapid optical scanning and multispectral imaging of the entire esophageal surface and provides diagnoses in near real time. By detecting and mapping suspicious sites, guided biopsy of invisible, precancerous dysplasia becomes practicable. Here we report the development of EPSS and its application in several clinical cases, one of which merits special consideration.

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Figure 1: Clinical EPSS instrument.
Figure 2: EPSS scanning esophageal epithelium during screening endoscopy.
Figure 3: EPSS spectra acquired during routine screening endoscopy.
Figure 4: Pseudo-color maps highlighting areas suspicious for dysplasia in five subjects.
Figure 5: HRE with NBI image of a location with invisible HGD.

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Acknowledgements

This study was supported by US National Institutes of Health grants EB003472 and RR017361, by US National Science Foundation grant BES0116833 and, in part, by the US Department of Veterans Affairs Office of Research and Development. We thank R. Chinnock and F. Bargoot of Optimum Technologies, Inc., for help with the fiber optic probe development. We thank Olympus for the loan of the endoscope used in the animal experiments.

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Affiliations

  1. Biomedical Imaging and Spectroscopy Laboratory and Department of Obstetrics, Gynecology and Reproductive Biology, Harvard University and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Le Qiu, Edward Vitkin, Sara Itani, Lianyu Guo, Mark D Modell, Eugene B Hanlon, Irving Itzkan & Lev T Perelman

  2. Division of Gastroenterology, Department of Medicine, Harvard University and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Douglas K Pleskow, Ram Chuttani, Jan Leyden, Nuri Ozden & Alana Sacks

  3. Department of Pathology, Harvard University and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Jeffrey D Goldsmith

  4. Department of Veterans Affairs, Medical Research Service and Geriatric Research Education and Clinical Center, Bedford, Massachusetts, USA

    Eugene B Hanlon

Authors
  1. Le Qiu
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  2. Douglas K Pleskow
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  3. Ram Chuttani
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  4. Edward Vitkin
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  5. Jan Leyden
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  6. Nuri Ozden
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  7. Sara Itani
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  8. Lianyu Guo
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  9. Alana Sacks
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  10. Jeffrey D Goldsmith
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  11. Mark D Modell
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  13. Irving Itzkan
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  14. Lev T Perelman
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Contributions

L.Q., E.V., M.D.M., E.B.H., I.I. and L.T.P. developed and evaluated the method; S.I., L.Q. and E.V. contributed codes for instrument control; D.K.P., R.C., J.D.G., J.L., N.O., L.G., L.Q. and A.S. performed clinical procedures; L.Q., D.K.P., R.C., E.B.H., I.I. and L.T.P. contributed to the writing of the manuscript; E.B.H., I.I., D.K.P., R.C. and L.T.P. designed and planned the project.

Corresponding author

Correspondence to Lev T Perelman.

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Competing interests

The authors declare no competing financial interests.

Supplementary information

Supplementary Text and Figures

Supplementary Figures 1–3 and Supplementary Methods (PDF 391 kb)

Supplementary Video 1

This video shows in real time the EPSS probe scanning a 2-cm section of esophagus during an endoscopy screening procedure. The regions of Barrett's esophagus, distributed in a diffuse pattern, appear darker in the video, which was acquired by the NBI mode of the endoscope. (MOV 9326 kb)

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Qiu, L., Pleskow, D., Chuttani, R. et al. Multispectral scanning during endoscopy guides biopsy of dysplasia in Barrett's esophagus. Nat Med 16, 603–606 (2010). https://doi.org/10.1038/nm.2138

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