Sturm Matthew B, Wang Thomas D
Division of Gastroenterology Departments of Medicine, Biomedical Engineering, Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.
Division of Gastroenterology Departments of Medicine, Biomedical Engineering, Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA Departments of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
Gut. 2015 Nov;64(11):1816-23. doi: 10.1136/gutjnl-2013-306706. Epub 2015 May 14.
The rapid rise in incidence of oesophageal adenocarcinoma has motivated the need for improved methods for surveillance of Barrett's oesophagus. Early neoplasia is flat in morphology and patchy in distribution and is difficult to detect with conventional white light endoscopy (WLE). Light offers numerous advantages for rapidly visualising the oesophagus, and advanced optical methods are being developed for wide-field and cross-sectional imaging to guide tissue biopsy and stage early neoplasia, respectively. We review key features of these promising methods and address their potential to improve detection of Barrett's neoplasia. The clinical performance of key advanced imaging technologies is reviewed, including (1) wide-field methods, such as high-definition WLE, chromoendoscopy, narrow-band imaging, autofluorescence and trimodal imaging and (2) cross-sectional techniques, such as optical coherence tomography, optical frequency domain imaging and confocal laser endomicroscopy. Some of these instruments are being adapted for molecular imaging to detect specific biological targets that are overexpressed in Barrett's neoplasia. Gene expression profiles are being used to identify early targets that appear before morphological changes can be visualised with white light. These targets are detected in vivo using exogenous probes, such as lectins, peptides, antibodies, affibodies and activatable enzymes that are labelled with fluorescence dyes to produce high contrast images. This emerging approach has potential to provide a 'red flag' to identify regions of premalignant mucosa, outline disease margins and guide therapy based on the underlying molecular mechanisms of cancer progression.
食管腺癌发病率的迅速上升促使人们需要改进巴雷特食管的监测方法。早期肿瘤在形态上呈扁平状，分布呈斑片状，难以用传统白光内镜检查（WLE）检测到。光在快速观察食管方面具有诸多优势，目前正在开发先进的光学方法用于广角和横断面成像，分别以指导组织活检和对早期肿瘤进行分期。我们综述了这些有前景的方法的关键特征，并探讨了它们在改善巴雷特肿瘤检测方面的潜力。本文回顾了关键先进成像技术的临床性能，包括（1）广角方法，如高清白光内镜检查、色素内镜检查、窄带成像、自体荧光成像和三模态成像，以及（2）横断面技术，如光学相干断层扫描、光学频域成像和共聚焦激光内镜显微镜检查。其中一些仪器正在被应用于分子成像，以检测在巴雷特肿瘤中过度表达的特定生物靶点。基因表达谱正被用于识别在形态学变化能用白光观察到之前出现的早期靶点。使用外源性探针在体内检测这些靶点，如用荧光染料标记的凝集素、肽、抗体、亲和体和可激活酶，以产生高对比度图像。这种新兴方法有潜力提供一个“警示信号”，以识别癌前黏膜区域、勾勒疾病边界，并基于癌症进展的潜在分子机制指导治疗。
