Research Service, VA Boston Healthcare System, 150 South Huntington Ave., Boston, MA, 02130, USA.
Department of Biomedical Engineering, College of Engineering, Boston University, 44 Cummington Mall, Boston, MA, 02215, USA.
Dig Dis Sci. 2022 Feb;67(2):613-621. doi: 10.1007/s10620-021-06901-x. Epub 2021 Mar 24.
Colonoscopic screening and surveillance for colorectal cancer could be made safer and more efficient if endoscopists could predict histology without the need to biopsy and perform histopathology on every polyp. Elastic-scattering spectroscopy (ESS), using fiberoptic probes integrated into standard biopsy tools, can assess, both in vivo and in real time, the scattering and absorption properties of tissue related to its underlying pathology.
The objective of this study was to evaluate prospectively the potential of ESS to predict polyp pathology accurately.
We obtained ESS measurements from patients undergoing screening/surveillance colonoscopy using an ESS fiberoptic probe integrated into biopsy forceps. The integrated forceps were used for tissue acquisition, following current standards of care, and optical measurement. All measurements were correlated to the index pathology. A machine learning model was then applied to measurements from 367 polyps in 169 patients to prospectively evaluate its predictive performance.
The model achieved sensitivity of 0.92, specificity of 0.87, negative predictive value (NPV) of 0.87, and high-confidence rate (HCR) of 0.84 for distinguishing 220 neoplastic polyps from 147 non-neoplastic polyps of all sizes. Among 138 neoplastic and 131 non-neoplastic polyps ≤ 5 mm, the model achieved sensitivity of 0.91, specificity of 0.88, NPV of 0.89, and HCR of 0.83.
Results show that ESS is a viable endoscopic platform for real-time polyp histology, particularly for polyps ≤ 5 mm. ESS is a simple, low-cost, clinically friendly, optical biopsy modality that, when interfaced with minimally obtrusive endoscopic tools, offers an attractive platform for in situ polyp assessment.
如果内镜医生能够在不需要活检的情况下预测组织学，并对每一个息肉进行组织病理学检查，那么结肠镜筛查和结直肠癌监测可以变得更加安全和高效。弹性散射光谱（ESS）使用集成到标准活检工具中的光纤探头，可以评估组织的散射和吸收特性，这些特性与潜在的病理学有关。
本研究旨在前瞻性评估 ESS 准确预测息肉病理的潜力。
我们使用集成在活检钳中的 ESS 光纤探头从接受筛查/监测结肠镜检查的患者中获得 ESS 测量值。根据当前的护理标准，使用集成的活检钳进行组织采集和光学测量。所有测量值均与索引病理学相关。然后，我们应用机器学习模型对 169 名患者的 367 个息肉进行前瞻性评估，以评估其预测性能。
该模型对区分 220 个肿瘤性息肉和 147 个非肿瘤性息肉的敏感性为 0.92，特异性为 0.87，阴性预测值（NPV）为 0.87，高置信度率（HCR）为 0.84。在 138 个肿瘤性和 131 个非肿瘤性息肉≤5mm 中，该模型的敏感性为 0.91，特异性为 0.88，NPV 为 0.89，HCR 为 0.83。
结果表明，ESS 是一种可行的实时息肉组织学内镜平台，特别是对于≤5mm 的息肉。ESS 是一种简单、低成本、临床友好的光学活检方法，当与微创性内镜工具结合使用时，为原位息肉评估提供了有吸引力的平台。
