Image-guided biopsy in the esophagus through comprehensive optical frequency domain imaging and laser marking: a study in living swine.
BACKGROUND
Random biopsy esophageal surveillance can be subject to sampling errors, resulting in diagnostic uncertainty. Optical frequency domain imaging (OFDI) is a high-speed, 3-dimensional endoscopic microscopy technique. When deployed through a balloon-centering catheter, OFDI can automatically image the entire distal esophagus (6.0 cm length) in approximately 2 minutes.


OBJECTIVE
To test a new platform for guided biopsy that allows the operator to select target regions of interest on an OFDI dataset, and then use a laser to mark the esophagus at corresponding locations. The specific goals include determining the optimal laser parameters, testing the accuracy of the laser marking process, evaluating the endoscopic visibility of the laser marks, and assessing the amount of mucosal damage produced by the laser.


METHODS
Experimental study conducted in 5 swine in vivo.


METHODS
Massachusetts General Hospital.


METHODS
Success rate, including endoscopic visibility of laser marks and accuracy of the laser marking process for selected target sites, and extent of the thermal damage caused by the laser marks.


RESULTS
All of the laser-induced marks were visible by endoscopy. Target locations were correctly marked with a success rate of 97.07% (95% confidence interval, 89.8%-99.7%). Thermal damage was limited to the superficial layers of the mucosa and was observed to partially heal within 2 days.


CONCLUSIONS
An animal study with artificially placed targets to simulate pathology.


CONCLUSIONS
The study demonstrates that laser marking of esophageal sites identified in comprehensive OFDI datasets is feasible and can be performed with sufficient accuracy, precision, and visibility to guide biopsy in vivo.
Suter
Melissa J
MJ
Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA. msuter@partners.org.
Jillella
Priyanka A
PA
Vakoc
Benjamin J
BJ
Halpern
Elkan F
EF
Mino-Kenudson
Mari
M
Lauwers
Gregory Y
GY
Bouma
Brett E
BE
Nishioka
Norman S
NS
Tearney
Guillermo J
GJ
D000818:Animals; D001707:Biopsy, Needle / Q000295:instrumentation*; D003952:Diagnostic Imaging / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005240:Feasibility Studies; D007089:Image Enhancement / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods; D007150:Immunohistochemistry; D007834:Lasers; D018613:Microscopy, Confocal / Q000379:methods; D023421:Models, Animal; D012680:Sensitivity and Specificity; D013552:Swine