Fluorescence spectroscopy incorporated in an Optical Biopsy System for the detection of early neoplasia in Barrett's esophagus
Fluorescence spectroscopy incorporated in an Optical Biopsy System for the detection of early neoplasia in Barrett's esophagus
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DOI：
10.1111/dote.12193
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发表时间：
2015-05-01
影响因子：
2.6
通讯作者：
Bergman, J. J.
中科院分区：
文献类型：
--
作者：
Boerwinkel, D. F.;Holz, J. A.;Bergman, J. J.
建议Barrett食管（BE）患者进行内镜监测，以检测高级别上皮内瘤变（HGIN）或早期癌症（EC）。早期肿瘤很难用白色光内窥镜检查发现，随机活检与取样误差有关。荧光光谱已被研究，以区分非发育异常的巴雷特上皮（NDBE）从早期瘤形成。光学活检系统（OBS）使用集成在常规活检钳中的光纤。这允许实时光谱分析，并确保光谱特征与相应的物理活检之间的精确相关性。OBS可以在BE监测期间提供易于使用的内窥镜工具。我们的目的是开发一种组织区分算法，并将OBS的鉴别特性与构建的算法与内窥镜医师对Barrett食管的评估相关联。在接受内窥镜检查的BE患者中，使用OBS对可疑肿瘤形成区域和内窥镜检查非可疑区域进行了研究，然后使用光学活检钳进行了相关的物理活检。光谱与组织学相关，并构建了一种算法，使用平滑线性判别分析来区分HGIN/EC和NDBE。构建的分类器进行内部交叉验证，并与内窥镜医师对BE段的评估相关。共纳入47例患者（39例男性，年龄66岁）：35例BE患者被转诊为早期肿瘤，12例NDBE患者。共对245个区域进行了以下组织学研究：43个HGIN/EC，66个低度上皮内瘤变，108个NDBE，28个胃或鳞状粘膜。排除低级别上皮内瘤变和胃/鳞状粘膜区域。构造的分类器的受试者工作特征曲线下的面积为0.78。NDBE和HGIN/EC的敏感性和特异性分别为81%和58%。当OBS与内镜医师的评估相结合时，敏感性为91%，特异性为50%。如果该方案指导了活检的决定，则可以避免一半的活检，但43个含有HGIN/EC的区域中有4个（9%）会被无意中归类为非可疑。在这项研究中，OBS被用来构建一个算法来区分肿瘤性BE和非肿瘤性BE。此外，OBS的可行性与构造的算法作为一个辅助工具，以内窥镜的评估在内窥镜BE监测。这些结果应在未来的研究中得到验证。此外，其他基于探针的光谱技术可以集成在该光学活检钳系统中。
Endoscopic surveillance is recommended for patients with Barrett's esophagus (BE) to detect high-grade intraepithelial neoplasia (HGIN) or early cancer (EC). Early neoplasia is difficult to detect with white light endoscopy and random biopsies are associated with sampling error. Fluorescence spectroscopy has been studied to distinguish non-dysplastic Barrett's epithelium (NDBE) from early neoplasia. The Optical Biopsy System (OBS) uses an optical fiber integrated in a regular biopsy forceps. This allows real-time spectroscopy and ensures spot-on correlation between the spectral signature and corresponding physical biopsy. The OBS may provide an easy-to-use endoscopic tool during BE surveillance. We aimed to develop a tissue-differentiating algorithm and correlate the discriminating properties of the OBS with the constructed algorithm to the endoscopist's assessment of the Barrett's esophagus. In BE patients undergoing endoscopy, areas suspicious for neoplasia and endoscopically non-suspicious areas were investigated with the OBS, followed by a correlating physical biopsy with the optical biopsy forceps. Spectra were correlated to histology and an algorithm was constructed to discriminate between HGIN/EC and NDBE using smoothed linear dicriminant analysis. The constructed classifier was internally cross-validated and correlated to the endoscopist's assessment of the BE segment. A total of 47 patients were included (39 males, age 66 years): 35 BE patients were referred with early neoplasia and 12 patients with NDBE. A total of 245 areas were investigated with following histology: 43 HGIN/EC, 66 low-grade intraepithelial neoplasia, 108 NDBE, 28 gastric or squamous mucosa. Areas with low-grade intraepithelial neoplasia and gastric/squamous mucosa were excluded. The area under the receiver operating characteristic curve of the constructed classifier was 0.78. Sensitivity and specificity for the discrimination between NDBE and HGIN/EC of OBS alone were 81% and 58% respectively. When OBS was combined with the endoscopist's assesssment, sensitivity was 91% and specificity 50%. If this protocol would have guided the decision to obtain biopsies, half of the biopsies would have been avoided, yet 4/43 areas containing HGIN/EC (9%) would have been inadvertently classified as unsuspicious. In this study, the OBS was used to construct an algorithm to discriminate neoplastic from non-neoplastic BE. Moreover, the feasibility of OBS with the constructed algorithm as an adjunctive tool to the endoscopist's assessment during endoscopic BE surveillance was demonstrated. These results should be validated in future studies. In addition, other probe-based spectroscopy techniques may be integrated in this optical biopsy forceps system.