TY - JOUR
T1 - Vital-dye enhanced fluorescence imaging of GI mucosa
T2 - Metaplasia, neoplasia, inflammation
AU - Thekkek, Nadhi
AU - Muldoon, Timothy
AU - Polydorides, Alexandros D.
AU - Maru, Dipen M.
AU - Harpaz, Noam
AU - Harris, Michael T.
AU - Hofstettor, Wayne
AU - Hiotis, Spiros P.
AU - Kim, Sanghyun A.
AU - Ky, Alex Jenny
AU - Anandasabapathy, Sharmila
AU - Richards-Kortum, Rebecca
N1 - Funding Information:
DISCLOSURE: Dr Richards-Kortum is an unpaid scientific advisor to, holds patents related to optical technologies licensed to, and holds minority ownership of Remicalm, LLC. Supported through the National Institutes of Health grants BRP CA103830 , RO1 EB007594 , and 1R01CA140257-01A1 . No other financial relationships relative to this publication were disclosed.
PY - 2012/4
Y1 - 2012/4
N2 - Background: Confocal endomicroscopy has revolutionized endoscopy by offering subcellular images of the GI epithelium; however, the field of view is limited. Multiscale endoscopy platforms that use widefield imaging are needed to better direct the placement of high-resolution probes. Design: Feasibility study. Objective: This study evaluated the feasibility of a single agent, proflavine hemisulfate, as a contrast medium during both widefield and high-resolution imaging to characterize the morphologic changes associated with a variety of GI conditions. Setting: The University of Texas MD Anderson Cancer Center, Houston, Texas, and Mount Sinai Medical Center, New York, New York. Patients, Interventions, and Main Outcome Measurements: Resected specimens were obtained from 15 patients undergoing EMR, esophagectomy, or colectomy. Proflavine hemisulfate, a vital fluorescent dye, was applied topically. The specimens were imaged with a widefield multispectral microscope and a high-resolution microendoscope. The images were compared with histopathologic examination. Results: Widefield fluorescence imaging enhanced visualization of morphology, including the presence and spatial distribution of glands, glandular distortion, atrophy, and crowding. High-resolution imaging of widefield abnormal areas revealed that neoplastic progression corresponded to glandular heterogeneity and nuclear crowding in dysplasia, with glandular effacement in carcinoma. These widefield and high-resolution image features correlated well with the histopathologic features. Limitations: This imaging approach must be validated in vivo with a larger sample size. Conclusions: Multiscale proflavine-enhanced fluorescence imaging can delineate epithelial changes in a variety of GI conditions. Distorted glandular features seen with widefield imaging could serve as a critical bridge to high-resolution probe placement. An endoscopic platform combining the two modalities with a single vital dye may facilitate point-of-care decision making by providing real-time, in vivo diagnoses.
AB - Background: Confocal endomicroscopy has revolutionized endoscopy by offering subcellular images of the GI epithelium; however, the field of view is limited. Multiscale endoscopy platforms that use widefield imaging are needed to better direct the placement of high-resolution probes. Design: Feasibility study. Objective: This study evaluated the feasibility of a single agent, proflavine hemisulfate, as a contrast medium during both widefield and high-resolution imaging to characterize the morphologic changes associated with a variety of GI conditions. Setting: The University of Texas MD Anderson Cancer Center, Houston, Texas, and Mount Sinai Medical Center, New York, New York. Patients, Interventions, and Main Outcome Measurements: Resected specimens were obtained from 15 patients undergoing EMR, esophagectomy, or colectomy. Proflavine hemisulfate, a vital fluorescent dye, was applied topically. The specimens were imaged with a widefield multispectral microscope and a high-resolution microendoscope. The images were compared with histopathologic examination. Results: Widefield fluorescence imaging enhanced visualization of morphology, including the presence and spatial distribution of glands, glandular distortion, atrophy, and crowding. High-resolution imaging of widefield abnormal areas revealed that neoplastic progression corresponded to glandular heterogeneity and nuclear crowding in dysplasia, with glandular effacement in carcinoma. These widefield and high-resolution image features correlated well with the histopathologic features. Limitations: This imaging approach must be validated in vivo with a larger sample size. Conclusions: Multiscale proflavine-enhanced fluorescence imaging can delineate epithelial changes in a variety of GI conditions. Distorted glandular features seen with widefield imaging could serve as a critical bridge to high-resolution probe placement. An endoscopic platform combining the two modalities with a single vital dye may facilitate point-of-care decision making by providing real-time, in vivo diagnoses.
UR - http://www.scopus.com/inward/record.url?scp=84862789337&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84862789337&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2011.10.004
DO - 10.1016/j.gie.2011.10.004
M3 - Article
C2 - 22301343
AN - SCOPUS:84862789337
SN - 0016-5107
VL - 75
SP - 877
EP - 887
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -