In Vivo Optical Detection of Dysplasia in Esophagus

项目摘要 食管腺癌是西方世界最常见的食道恶性肿瘤， 在美国上升最快的恶性肿瘤--在过去的30年里，每年大约增长7% 好几年了。预后非常差，确诊后5年存活的患者不到15%。世界范围内， 2008年发生482,300例新的食道癌病例和406,800例死亡。为了让患者 为了存活下来，在早期、发育不良阶段诊断这种恶性肿瘤是至关重要的。我们的团队已经 开发了一种内窥镜偏振光谱扫描仪(EPSS)，它可以实时提供 关于隐形高度异型增生位置的活体信息。这与现有的 商用内窥镜、多光谱成像仪是基于光散射技术的 光谱学(LSS)，能够识别各种上皮衬里器官中的癌前病变，例如 食管。EPSS成像仪在几分钟内扫描整个食道，提供 具有用于指导活检的实时诊断信息的医生。 同时，为了建立EPSS方法的无偏特征，并 为胃肠病专家提供所需的准确的定量组织学和生化信息 可视化食道上皮隐形异型增生重要的技术改进和 还需要进行更多的临床研究。对于这一竞争性续订计划，我们将建立一个重要的 改进的便携式EPSS仪器，能够更快地扫描整个食道数量级 然后利用现有仪器，深度解析上皮结构，并连续投射定量 内窥镜检查视频中的组织学和生化以及诊断成像信息 时间到了。 与最先进的广域技术相比，EPSS的独特之处在于其定位能力 白光或白光观察时未见明显异常或损害的组织中的不典型增生 荧光。通过用宏观光谱测量来阐明微观亚细胞结构， EPSS可以独立于任何视觉线索来定位发育不良的组织。我们的结论是，EPSS提供了很好的 承诺早期发现Barrett‘s食道异型增生。如果EPSS技术 用于常规指导活检，将避免不必要的活检，并将局灶性发育不良斑点 否则就会错过的活组织检查。

Project Summary Esophageal adenocarcinoma is the most common esophageal malignancy in Western world and the malignancy that is rising the fastest in the United States – approximately 7% per year over the past 30 years. It has very poor prognosis with less than 15% of patients alive 5 years after diagnosis. Worldwide, 482,300 new esophageal cancer cases and 406,800 deaths occurred in 2008. In order for patients to survive, it is essential to diagnose this malignancy at an early, dysplastic stage. Our group has developed an endoscopic polarized spectroscopic scanning (EPSS) instrument which gives real time in vivo information on the location of invisible high grade dysplasia. This, compatible with existing commercial endoscopes, multispectral imaging instrument is based on the technique of light scattering spectroscopy (LSS), capable of identifying pre-cancer in various epithelial-lined organs, such as esophagus. The EPSS imaging instrument scans the entire esophagus in a matter of minutes providing the physician with real time diagnostic information for guiding biopsy. At the same time, in order to establish unbiased characteristics of the EPSS method and to provide gastroenterologists with accurate quantitative histological and biochemical information needed to visualize invisible dysplasia in esophageal epithelium important technological improvements and additional clinical studies are required. For this competitive renewal program we will build a significantly improved portable EPSS instrument capable of scanning the entire esophagus order of magnitude faster then the existing instrument, depth resolving epithelial structure, and continuously projecting quantitative histological and biochemical as well as diagnostic imaging information on the endoscopy video in real time. Compared to state-of-the-art wide-field techniques, EPSS is distinguished by its ability to locate dysplasia in tissue that shows no visible abnormalities or lesions when observed with white light or fluorescence. By elucidating microscopic subcellular structure with macroscopic spectral measurements, EPSS can locate dysplastic tissue independent of any visual cues. We conclude that EPSS offers great promise for the early detection of dysplasia in Barrett's esophagus. If the EPSS technique were to be used to guide biopsy routinely, unnecessary biopsies would be avoided and focal dysplastic spots would be biopsied that otherwise would be missed.