In Vivo Optical Detection of Dysplasia in Esophagus

描述（申请人提供）：我们小组最近开发了一种内窥镜偏振光谱扫描（EPSS）仪器。EPSS仪器提供实时的活体信息，关于高级别不典型增生（HGD）的位置，这是一种传统的腺癌预测因子。该仪器基于光散射光谱（LSS）技术，与现有的商用内窥镜兼容。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仪器是单点仪器的一个重大进步，因为：(1)它扫描整个食道；(2)将数据分析软件与仪器集成，为医生提供实时诊断信息，指导活检；(3)它采用准直照明和采集光学，使上皮组织的多光谱映射不受蠕动运动的影响；(4)将单后向散射LSS信号中去除无用背景的极化技术与漫反射光谱信号相结合，提高了诊断评估能力。在其第一次测试中，新的EPSS仪器成功地指导了食管活检，检测和定位了食管上皮中不可见的癌前不典型增生的位置，这是目前的护理标准所遗漏的。然而，为了建立新仪器的无偏特性，并为胃肠病学家提供准确的、运动调节的食管上皮不可见发育不良的实时地图，需要进行重要的技术改进和额外的临床研究。对于这个竞争性更新项目，我们将(1)构建一个改进的便携式EPSS仪器，(2)重新设计偏振扫描光纤探头，(3)改进实时组织学和诊断算法，(4)改进实时制导系统。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，在监测内窥镜期间对BE患者进行未来癌症风险的分类。

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.