Biophotonics to Couple Pancreatic with Upper GI Screening via Ultrathin Endoscopy

描述(申请人提供)：上消化道恶性肿瘤(食道、胃和胰腺)是美国人癌症死亡的主要原因之一，主要是因为它的隐匿性导致晚期诊断。超薄上部内窥镜的临床应用有可能为癌症筛查提供一种主要手段，因为它比传统的大口径内窥镜更舒适，从而允许患者放弃镇静，从而改变并发症、成本和便利性。然而，到目前为止，这一承诺还没有实现，很大程度上是因为上消化道内窥镜未能检测出胰腺癌(PC)，其发病率使食道癌和胃癌相形见绌。我们由生物医学工程师、癌症生物标记物专家和胃肠病专家组成的多学科小组专注于使用一种新技术--低相干增强背向散射(LEBS)来检测现场致癌过程中遗传/表观遗传/生理变化的超微结构和微血管后果。虽然我们之前的工作主要集中在结肠(在结肠中，“被宣告死亡的粘膜”是评估同步/异时性腺瘤的临床必要性)，但我们的数据表明，对组织学和内窥镜下正常的十二指肠壶腹周围粘膜的分析可以预测PC(与其他关于遗传/表观遗传事件的报告一致)。我们使用需要较大工作通道的LEBS光纤探头的初步数据显示了强大的诊断性能。然而，为了使这一策略在临床上可行，探针必须被微型化，这样才能通过超薄内窥镜进行输送。因此，我们建议开发一种新型的微型亚扩散辐射传输光纤阵列探头，以与超薄内窥镜的2 mm辅助通道兼容。我们将在两种情况下评估临床价值：PC筛查和囊性肿瘤治疗。通过筛查，我们将进行一项具有独立验证集的病例对照研究，以测试通过PC筛查探针在十二指肠壶腹周围粘膜检测现场癌变的超微结构和微血管标志物的可能性。对于囊性肿瘤的治疗，我们将评估十二指肠问诊对囊性诊断和具有中等恶性风险的囊性病变(IPMNS)的预测的价值，这两个问题都是临床棘手的问题。通过将超薄内窥镜与十二指肠壶腹周围粘膜PC野癌变的光学检测相结合，我们建议克服迄今为止在人群中进行上消化道癌症筛查的主要障碍。该测试可以在办公室环境中舒适地进行，同时将成本、患者不便和并发症降至最低。这也可能应用于监测风险较高的患者，包括患有IPMN的患者。最后，这可能预示着生物光子学研究的另一条途径，专注于风险分层，而不是光学活检或异型增生检测。

DESCRIPTION (provided by applicant): Upper gastrointestinal malignancies (esophageal, gastric and pancreatic) are one of the leading causes of cancer deaths among Americans largely due to its insidious nature leading to diagnosis at late stages. The clinical implementatio of ultrathin upper endoscopes has the potential for providing a major modality for cancer screening in that it is much more comfortable than conventional larger caliber endoscopes thus allowing patients to forego sedation with the consequent change in complications, cost and convenience. However, the promise has heretofore not been realized largely because of the failure of upper endoscopy to detect pancreatic cancer (PC), whose incidence dwarfs esophageal and gastric cancers. Our multi-disciplinary group of biomedical engineers, cancer biomarkers experts, gastroenterologists has focused on using a novel technology, low coherence enhanced backscattering (LEBS) to detect the ultra-structural and microvascular consequences of the genetic/epigenetic/physiological alterations in field carcinogenesis. While our prior work has largely focused on the colon (where the "condemned mucosa" is the clinical imperative behind assessment for synchronous/metachronous adenomas), our data have shown that the analysis of histologically and endoscopically normal duodenal peri-ampullary mucosa could predict PC (consistent with other reports on genetic/epigenetic events). Our preliminary data with a LEBS fiber-optic probe requiring a large working channel shows strong diagnostic performance. For this strategy to be clinically viable, however, the probe has to be miniaturized so that it can be delivered through ultrathin endoscopes. Therefore, we propose to develop a novel miniature sub-diffusion radiative transport fiber-array probe to be compatible with the 2 mm accessory channel of an ultrathin endoscope. We will assess clinical value in two scenarios: PC screening and cystic neoplasm management. With screening we will perform a case-control study with an independent validation set to test the potential of detecting the ultrastructural and microvascular markers of field carcinogenesis in the duodenal peri-ampullary mucosa via the probe for PC screening. For cystic neoplasm management, we will assess the value of duodenal interrogation for cyst diagnosis and prognostication of cysts with intermediate malignancy risk (IPMNs), both clinically vexing issues. By bridging ultrathin endoscopy with optical detection of PC field carcinogenesis in the duodenal periampullary mucosa, we propose to overcome what is arguably the major barrier thus far preventing upper GI cancer screening in population. The test could be performed comfortably in the office setting while minimizing cost, patient inconvenience and complications. This may also have applications for surveillance of patients at higher risk including those with IPMNs. Finally, this may herald another avenue in biophotonics research focusing on risk stratification as opposed to optical biopsy or dysplasia detection.