Gastroenterology

Gastroenterology

Volume 120, Issue 7, June 2001, Pages 1620-1629
Gastroenterology

Alimentary Tract
Fluorescence, reflectance, and light-scattering spectroscopy for evaluating dysplasia in patients with Barrett's esophagus*,**

https://doi.org/10.1053/gast.2001.24842Get rights and content

Abstract

Background & Aims: The aim of this study was to assess the potential of 3 spectroscopic techniques (fluorescence, reflectance, and light-scattering spectroscopy) individually and in combination, for evaluating low- and high-grade dysplasia in patients with Barrett's esophagus (BE). Methods: Fluorescence spectra at 11 excitation wavelengths and a reflectance spectrum were acquired in approximately 1 second from each site before biopsy using an optical fiber probe. The measured fluorescence spectra were combined with the reflectance spectra to extract the intrinsic tissue fluorescence. The reflectance spectra provided morphologic information about the bulk tissue, whereas light-scattering spectroscopy was used to determine cell nuclear crowding and enlargement in Barrett's epithelium. Results: Significant differences were observed between dysplastic and nondysplastic BE in terms of intrinsic fluorescence, bulk scattering properties, and levels of epithelial cell nuclear crowding and enlargement. The combination of all 3 techniques resulted in superior sensitivity and specificity for separating high-grade from non–high-grade and dysplastic from nondysplastic epithelium. Conclusions: Intrinsic fluorescence, reflectance, and light-scattering spectroscopies provide complementary information about biochemical and morphologic changes that occur during the development of dysplasia. The combination of these techniques (Tri-Modal Spectroscopy) can serve as an excellent tool for the evaluation of dysplasia in BE.

GASTROENTEROLOGY 2001;120:1620-1629

Section snippets

Materials and methods

The study was conducted at the Brigham and Women's Hospital and the West Roxbury Veterans Administration Medical Center. The protocol was approved by the Institutional Review Boards of both hospitals, as well as by the Committee On the Use of Humans as Experimental Subjects of the Massachusetts Institute of Technology. Data were collected from 16 patients with known BE undergoing standard surveillance protocols.

Measurements were performed using a fast excitation-emission matrix (EEM) instrument

Extracting the intrinsic tissue fluorescence

Figure 2A shows a typical fluorescence spectrum excited with 337 nm light from a nondysplastic BE site (solid line).

. (A) Fluorescence from a nondysplastic BE site, 337-nm excitation. Measured spectrum, solid line; extracted intrinsic fluorescence, dashed line. (B) Corresponding reflectance spectrum.

There are 2 peaks, which might be attributed to the presence of 2 different tissue fluorophores. However, note that the fluorescence intensity decrease between these 2 peaks occurs in the 420-nm

Discussion

Spectroscopic techniques use information contained in light signals to assess the state of biological tissue. Optical fiber technology allows spectroscopy to be applied as a diagnostic tool for a wide range of tissues that are accessible endoscopically. Indeed, the use of spectroscopy as a means of improving the physician's ability to detect precancerous (dysplastic) and early cancerous lesions is pursued actively in many organs, such as the oral cavity,35, 36, 37, 38 the cervix,39, 40 the lung,

References (47)

  • MF Mitchell et al.

    Fluorescence spectroscopy for diagnosis of squamous intraepithelial lesions of the cervix

    Obstet Gynecol

    (1999)
  • S Lam et al.

    Detection of dysplasia and carcinoma in situ with a lung imaging fluorescence endoscope device

    J Thor Cardiovasc Surg

    (1993)
  • RM Cothren et al.

    Gastrointestinal tissue diagnosis by laser-induced fluorescence spectroscopy at endoscopy

    Gastrointest Endosc

    (1990)
  • KT Schomacker et al.

    Ultraviolet laser-induced fluorescence of colonic polyps

    Gastroenterology

    (1992)
  • MA Mycek et al.

    Colonic polyp differentiation using time-resolved autofluorescence spectroscopy

    Gastrointest Endosc

    (1998)
  • L Herszenyi et al.

    Proteases in gastrointestinal neoplastic diseases

    Clin Chim Acta

    (2000)
  • D Antonioli

    The esophagus

  • JW Van Sandick et al.

    Impact of endoscopic biopsy surveillance of Barrett's esophagus on pathological stage and clinical outcome of Barrett's carcinoma

    Gut

    (1998)
  • RE Petras et al.

    Barrett's esophagus. A review of the pathologist's role in diagnosis and management

    Pathol Annual

    (1991)
  • T Vo-Dinh et al.

    In vivo diagnosis of the esophagus using differential normalized fluorescence (DNF) indices

    Lasers Surg Med

    (1995)
  • T Vo-Dinh et al.

    Laser-induced fluorescence for esophageal cancer and dysplasia diagnosis

    Ann N Y Acad Sci

    (1998)
  • H Stepp et al.

    Fluorescence endoscopy of gastrointestinal diseases: basic principles, techniques, and clinical experience

    Endoscopy

    (1998)
  • DR Braichotte et al.

    Clinical pharmacokinetic studies of Photofrin by fluorescence spectroscopy in the oral cavity, the esophagus, and the bronchi

    Cancer

    (1995)
  • Cited by (0)

    *

    Address requests for reprints to: Irene Georgakoudi, Ph.D., Massachusetts Institute of Technology, G.R. Harrison Spectroscopy Laboratory, 77 Massachusetts Avenue, Room 6-014, Cambridge, Massachusetts 09139. e-mail: [email protected]; fax: (617) 253-4513.

    **

    Supported by National Institutes of Health grants P41RR02594 and CA53717, and by an NIH NRSA fellowship (to I.G.).

    View full text