VA Boston Healthcare System, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Ann N Y Acad Sci. 2020 Dec;1482(1):61-76. doi: 10.1111/nyas.14523. Epub 2020 Nov 12.
Esophageal cancers, largely adenocarcinoma in Western countries and squamous cell cancer in Asia, present a significant burden of disease and remain one of the most lethal of cancers. Key to improving survival is the development and adoption of new imaging modalities to identify early neoplastic lesions, which may be small, multifocal, subsurface, and difficult to detect by standard endoscopy. Such advanced imaging is particularly relevant with the emergence of ablative techniques that often require multiple endoscopic sessions and may be complicated by bleeding, pain, strictures, and recurrences. Assessing the specific location, depth of involvement, and features correlated with neoplastic progression or incomplete treatment may optimize treatments. While not comprehensive of all endoscopic imaging modalities, we review here some of the recent advances in endoscopic luminal imaging, particularly with surface contrast enhancement using virtual chromoendoscopy, highly magnified subsurface imaging with confocal endomicroscopy, optical coherence tomography, elastic scattering spectroscopy, angle-resolved low-coherence interferometry, and light scattering spectroscopy. While there is no single ideal imaging modality, various multimodal instruments are also being investigated. The future of combining computer-aided assessments, molecular markers, and improved imaging technologies to help localize and ablate early neoplastic lesions shed hope for improved disease outcome.
食管癌,在西方国家主要为腺癌,在亚洲为鳞状细胞癌,疾病负担巨大,仍然是最致命的癌症之一。提高生存率的关键是开发和采用新的成像方式来识别早期肿瘤病变,这些病变可能很小、多灶性、位于黏膜下层,并且难以通过标准内镜检测到。随着消融技术的出现,这种先进的成像技术变得尤为重要,这些技术通常需要多次内镜检查,并且可能会出现出血、疼痛、狭窄和复发等并发症。评估特定位置、受累深度以及与肿瘤进展或治疗不彻底相关的特征,可能会优化治疗效果。虽然这里没有全面介绍所有内镜成像方式,但我们回顾了一些内镜管腔成像的最新进展,特别是使用虚拟 chromoendoscopy 增强表面对比度、使用共聚焦内镜进行高倍放大黏膜下层成像、光学相干断层扫描、弹性散射光谱学、角度分辨低相干干涉测量和光散射光谱学。虽然没有单一的理想成像方式,但也在研究各种多模态仪器。结合计算机辅助评估、分子标志物和改进的成像技术来帮助定位和消融早期肿瘤病变的未来,为改善疾病预后带来了希望。
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