Association between rectal optical signatures and colonic neoplasia: potential applications for screening.
Field carcinogenesis detection represents a promising means for colorectal cancer (CRC) screening, although current techniques (e.g., flexible sigmoidoscopy) lack the requisite sensitivity. The novel optical technology low-coherence enhanced backscattering (LEBS) spectroscopy, allows identification of microscale architectural consequences of the field carcinogenesis in preclinical CRC models with unprecedented accuracy. To investigate the potential clinical translatability of this approach, we obtained biopsies from the normal-appearing rectal mucosa from patients undergoing colonoscopy (n = 219). LEBS signals were recorded through a bench-top instrument. Four parameters characterizing LEBS signal were linearly combined into a single marker. We found that LEBS signal parameters generally mirrored neoplasia progression from patients with no neoplasia, to 5 to 9 mm adenoma and to advanced adenomas. The composite LEBS marker calculated from the LEBS signal paralleled this risk status (ANOVA P < 0.001). Moreover, this was independent of CRC risk factors, benign colonic findings, or clinically unimportant lesions (diminutive adenomas, hyperplastic polyps). For advanced adenomas, the LEBS marker had a sensitivity of 100%, specificity of 80%, and area under the receiver operator characteristic curve of 0.895. Leave-one-out cross-validation and an independent data set (n = 51) supported the robustness of these findings. In conclusion, we provide the first demonstration that LEBS-detectable alterations in the endoscopically normal rectum were associated with the presence of neoplasia located elsewhere in the colon. This study provides the proof of concept that rectal LEBS analysis may potentially provide a minimally intrusive CRC screening technique. Further studies with an endoscopically compatible fiber optic probe are under way for multicenter clinical validation.
Roy
Hemant K
HK
Department of Medicine, Evanston-Northwestern Healthcare, Northwestern University, Evanston, IL 60201, USA. h-roy@northwestern.edu
Turzhitsky
Vladimir
V
Kim
Young
Y
Goldberg
Michael J
MJ
Watson
Patrice
P
Rogers
Jeremy D
JD
Gomes
Andrew J
AJ
Kromine
Alexey
A
Brand
Randall E
RE
Jameel
Mohammed
M
Bogovejic
Andrej
A
Pradhan
Prabhakar
P
Backman
Vadim
V
D000236:Adenoma / Q000175:diagnosis / Q000473:pathology; D000704:Analysis of Variance; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D003111:Colonic Polyps / Q000175:diagnosis / Q000473:pathology; D003113:Colonoscopy; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D011127:Polyps / Q000175:diagnosis / Q000473:pathology; D012007:Rectum / Q000473:pathology*; D015203:Reproducibility of Results; D012307:Risk Factors; D012812:Sigmoidoscopy; D041623:Tomography, Optical Coherence