Coda Sergio, Siersema Peter D, Stamp Gordon W H, Thillainayagam Andrew V
Section of Gastroenterology and Hepatology, Department of Medicine, Imperial College London, London, United Kingdom ; Photonics Group, Department of Physics, Imperial College London, London, United Kingdom ; Endoscopy Unit, Department of Gastroenterology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom ; Department of Endoscopy, North East London NHS Treatment Centre, Care UK, London, United Kingdom.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Endosc Int Open. 2015 Oct;3(5):E380-92. doi: 10.1055/s-0034-1392513. Epub 2015 Sep 8.
Detection, characterization, and staging constitute the fundamental elements in the endoscopic diagnosis of gastrointestinal diseases, but histology still remains the diagnostic gold standard. New developments in endoscopic techniques may challenge histopathology in the near future. An ideal endoscopic technique should combine a wide-field, "red flag" screening technique with an optical contrast or microscopy method for characterization and staging, all simultaneously available during the procedure. In theory, biophotonic advances have the potential to unite these elements to allow in vivo "optical biopsy." These techniques may ultimately offer the potential to increase the rates of detection of high risk lesions and the ability to target biopsies and resections, and so reduce the need for biopsy, costs, and uncertainty for patients. However, their utility and sensitivity in clinical practice must be evaluated against those of conventional histopathology. This review describes some of the most recent applications of biophotonics in endoscopic optical imaging and metrology, along with their fundamental principles and the clinical experience that has been acquired in their deployment as tools for the endoscopist. Particular emphasis has been placed on translational label-free optical techniques, such as fluorescence spectroscopy, fluorescence lifetime imaging microscopy (FLIM), two-photon and multi-photon microscopy, second harmonic generation (SHG) and third harmonic generation (THG) imaging, optical coherence tomography (OCT), diffuse reflectance, Raman spectroscopy, and molecular imaging.
检测、特征描述和分期是胃肠道疾病内镜诊断的基本要素，但组织学仍然是诊断的金标准。内镜技术的新发展在不久的将来可能会对组织病理学提出挑战。理想的内镜技术应将广视野的“警示信号”筛查技术与用于特征描述和分期的光学对比或显微镜方法相结合，并且在操作过程中所有这些都能同时实现。从理论上讲，生物光子学的进展有潜力将这些要素结合起来，实现体内“光学活检”。这些技术最终可能提高高危病变的检测率以及靶向活检和切除的能力，从而减少活检需求、成本以及患者的不确定性。然而，必须将它们在临床实践中的效用和敏感性与传统组织病理学的进行评估对比。本综述描述了生物光子学在内镜光学成像和计量学中的一些最新应用，以及它们的基本原理和作为内镜医生工具在应用过程中所获得的临床经验。特别强调了无标记光学技术的转化应用，如荧光光谱法、荧光寿命成像显微镜（FLIM）、双光子和多光子显微镜、二次谐波产生（SHG）和三次谐波产生（THG）成像、光学相干断层扫描（OCT）、漫反射、拉曼光谱和分子成像。
