In Vivo Optical Detection of Dysplasia in Esophagus

描述（由申请人提供）：我们的团队最近开发了一种内窥镜偏振光谱扫描（EPSS）仪器。EPSS仪器提供了真实的时间，在体内，高度异型增生（HGD），腺癌的传统预测的位置信息。该仪器基于光散射光谱（LSS）技术，与现有市售内窥镜兼容。LSS在一项原理验证研究中成功证明了在包括巴雷特食管（BE）在内的五种不同器官的上皮组织中识别癌前病变的能力。EPSS仪器相对于单点仪器的显著进步在于：（1）它扫描整个食管;（2）它将数据分析软件与仪器集成，以便为医生提供用于引导活检的真实的诊断信息;（3）它采用准直照明和收集光学器件，使得能够对不受蠕动运动影响的上皮组织进行多光谱映射;（4）结合了偏振技术和漫反射光谱信号，提高了诊断评估能力。在其第一次测试中，新的EPSS仪器成功地引导了食管活检，检测和映射了当前标准护理遗漏的食管上皮中不可见的癌前异型增生部位。 然而，为了建立新仪器的无偏特性，并为胃肠病学家提供食管上皮中不可见异型增生的准确的、运动调整的真实的时间图，需要重要的技术改进和额外的临床研究。对于该竞争性更新计划，我们将（1）构建EPSS仪器的改进便携式版本，（2）重新设计偏振扫描光纤探头，（3）改进真实的时间组织学和诊断算法，以及（4）改进真实的时间引导系统。我们还将测试新的EPSS仪器的能力，为胃肠病学家提供一个准确的工具，以分类BE患者在未来的癌症风险，在监测内窥镜检查。 公共卫生相关性：该计划的目的是为胃肠病学家提供一种诊断筛查工具，使他能够快速调查患有这种疾病的患者的Barrett食管（BE）区域，并允许他以高概率和实时确定异型增生和癌的区域。这种方法大大上级目前进行系统或随机活检的策略。因此，它将提供一个强大的工具，筛选大量的巴雷特食管患者的早期癌前病变。

DESCRIPTION (provided by applicant): Our group has recently developed an endoscopic polarized spectroscopic scanning (EPSS) instrument. The EPSS instrument gives real time, in vivo, information on the location of high grade dysplasia (HGD), a traditional predictor of adenocarcinoma. This instrument, compatible with existing commercial endoscopes, is based on the technique of light scattering spectroscopy (LSS). LSS successfully demonstrated in a proof-of-principle study the ability to identify pre-cancer in the epithelial tissue of five different organs, including Barrett's esophagus (BE). The EPSS instrument is a significant advance over the single-point instrument in that: (1) it scans the entire esophagus; (2) it integrates the data analysis software with the instrument in order to provide the physician with real time diagnostic information for guiding biopsy; (3) it employs collimated illumination and collection optics, enabling multispectral mapping of epithelial tissue unaffected by peristaltic motion; (4) it incorporates both the polarization technique for removing the unwanted background in the single backscattering LSS signal, and the diffuse reflectance spectroscopy signal, thereby improving the diagnostic assessment capability. In its first test, the new EPSS instrument successfully guided biopsy in the esophagus, detecting and mapping sites of invisible precancerous dysplasia in esophageal epithelium missed by the current standard-of-care. However, in order to establish unbiased characteristics of the new instrument and to provide gastroenterologist with an accurate, motion adjusted real time map of invisible dysplasia in esophageal epithelium, important technological improvements and additional clinical studies are required. For this competitive renewal program we will (1) build an improved portable version of the EPSS instrument, (2) redesign the polarized scanning fiber probe, (3) improve real time histological and diagnostic algorithms and (4) improve real time guidance system. We also will test the ability of the new EPSS instrument to provide the gastroenterologist with an accurate tool to classify patients with BE at risk for future cancer during surveillance endoscopy. PUBLIC HEALTH RELEVANCE: The purpose of this program is to provide the gastroenterologist with a diagnostic screening tool which will enable him to rapidly survey the region of Barrett's esophagus (BE) in a patient with this disease, and allow him to determine with high probability and in real-time, regions of dysplasia and carcinoma. This approach is vastly superior to the present strategies of performing either systematic or random biopsies. Thus it will provide a powerful tool for screening the large population of Barrett's esophagus patients for early precancerous changes.