title: Fluorescence imaging for the detection of early neoplasia in Barrett's esophagus: old looks or new vision?
abstract: Early neoplasia arising from Barrett's esophagus is often small, focally distributed and endoscopically poorly visible, and random four-quandrant biopsies may easily miss early lesions. Advanced imaging techniques, such as (auto)fluorescence-based modalities, aim to increase the detection rate of early lesions or the yield of random biopsies. Fluorescence-based light-tissue interaction has been designed successfully in point-probe differentiating spectroscopy systems or integrated into wide-field endoscopic systems such as autofluorescence imaging (AFI). In this review, we discuss the most recent advances in fluorescence spectroscopy and imaging for detecting early Barrett's neoplasia. A spectroscopy probe, integrated into regular biopsy forceps, was shown to offer decent discriminatory capabilities, while ensuring spot-on correlation between the measured area and the corresponding histology. With this tool, surveillance endoscopy with random biopsies may become more efficient and sensitive. AFI was shown to increase the targeted detection of early neoplasia. However, random biopsies could compensate for this effect. The clinical impact of AFI on the diagnosis and the treatment of early neoplasia is limited, and yet AFI may offer a novel approach in biomarker-based risk-stratification models. Moreover, in combination with new, readily available contrast agents such as fluorescent lectins, fluorescence imaging may receive renewed interest.
authors.affiliation: aDepartment of Gastroenterology and Hepatology bDepartment of Biomedical Engineering and Physics, Academic Medical Centre, Amsterdam, The Netherlands cMRC Cancer Cell Unit, Hutchison/MRC Research Centre, Cambridge, UK.
authors.forename: David F
authors.initials: DF
authors.lastname: Boerwinkel
authors.forename: M Kareem
authors.initials: MK
authors.lastname: Shariff
authors.forename: Massimiliano
authors.initials: M
authors.lastname: di Pietro
authors.forename: Jasmin A
authors.initials: JA
authors.lastname: Holz
authors.forename: Maurice C
authors.initials: MC
authors.lastname: Aalders
authors.forename: Wouter L
authors.initials: WL
authors.lastname: Curvers
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Fitzgerald
authors.forename: Jacques J
authors.initials: JJ
authors.lastname: Bergman
mesh_terms: D001471:Barrett Esophagus / Q000175:diagnosis* / Q000473:pathology; D001706:Biopsy / Q000379:methods; D042241:Early Diagnosis; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D008856:Microscopy, Fluorescence / Q000379:methods*; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology