Fiber-optic confocal Raman spectroscopy for real-time in vivo diagnosis of dysplasia in Barrett's esophagus
Menée sur 77 patients présentant un endobrachyœsophage, cette étude évalue la sensibilité et la spécificité d'une spectrométrie confocale Raman à fibre optique pour détecter précocement in vivo et en temps réel une dysplasie
Background & Aims : Barrett’s esophagus (BE) is a condition that poses high risk of developing dysplasia into esophageal adenocarcinoma. Early detection of dysplasia in BE is critical to improving survival rates of the patients. The current diagnostic approaches to detecting BE rely on random biopsy sampling guidelines, resulting in a vast number of negative biopsies. Raman spectroscopy is a unique optical vibrational technique capable of probing biochemical and biomolecular changes of tissue associated with neoplastic transformation without labeling. This work aims to evaluate the utility of a rapid fiber-optic confocal Raman spectroscopy technique for real-time in vivo diagnosis of dysplasia in BE at endoscopy.
Methods : An endoscope-based fiber-optic confocal Raman spectroscopy technique developed together with Raman reference database acquired from 373 patients is applied for prospective diagnostics of 77 BE patients in vivo during gastrointestinal endoscopy. The confocal Raman diagnostic results are compared with histopathology in a blinded fashion.
Results : High-quality tissue Raman spectra can be acquired from esophagus in vivo in real-time. Confocal Raman spectra show significantly spectral differences (P < .001, unpaired two-sided Student’s t-test) among different esophageal tissue types (i.e., columnar-lined epithelium, non-dysplastic BE and dysplastic BE). Fiber-optic confocal Raman spectroscopy in conjunction with partial least squares- discriminant analysis provides a diagnostic sensitivity of 87.0% (67/77) and a specificity of 84.7% (610/720) for in vivo detection of dysplasia in 77 BE patients prospectively based on endogenous biomolecular signatures.
Conclusions : This work demonstrates for the first time that the real-time fiber-optic confocal Raman spectroscopy can be used to accurately detect dysplasia in Barrett's esophagus in vivo at the molecular level during clinical endoscopy.
Gastroenterology , résumé, 2012