In Vivo Optical Detection of Dysplasia in Esophagus

描述(申请人提供)：我们团队最近开发了一种内窥镜偏振光谱扫描(EPSS)仪器。EPSS仪器在活体内实时提供高级别异型增生(HGD)的位置信息，HGD是腺癌的传统预测指标。该仪器与现有的商用内窥镜兼容，基于光散射光谱(LSS)技术。LSS在一项原则验证研究中成功地证明了在包括巴雷特食道(BE)在内的五个不同器官的上皮组织中识别癌症前病变的能力。EPSS仪器是单点仪器在以下方面的重大进步：(1)它扫描整个食道；(2)它将数据分析软件与仪器集成，以便为医生提供实时诊断信息以指导活检；(3)它采用准直照明和采集光学技术，能够对不受蠕动影响的上皮组织进行多光谱标测；(4)它同时采用偏振技术和漫反射光谱信号，以消除单一后向散射LSS信号中的多余背景，从而提高诊断评估能力。在第一次测试中，新的EPSS仪器成功地引导了食道活检，检测和绘制了当前护理标准遗漏的食道上皮隐形癌前异常增生部位。然而，为了建立新仪器的无偏特性，并为胃肠科医生提供准确的、运动调整的食道上皮隐形异常的实时地图，需要重要的技术改进和更多的临床研究。对于这一竞争性更新计划，我们将(1)构建改进的便携式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)改进实时引导系统。我们还将测试新的EPSS仪器的能力，为胃肠病医生提供准确的工具，在监视内窥镜检查期间对有癌症风险的患者进行分类。 公共卫生相关性：该计划的目的是为胃肠病专家提供一种诊断筛查工具，使他能够快速测量患有这种疾病的患者的巴雷特食道(BE)区域，并允许他以高概率和实时的方式确定不典型增生和癌的区域。这种方法大大优于目前进行系统或随机活组织检查的策略。因此，它将为筛查大量Barrett‘s食道患者的早期癌前病变提供强有力的工具。

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.