title: Diagnosis of neoplasia in Barrett's esophagus using vital-dye enhanced fluorescence imaging.
abstract: The ability to differentiate benign metaplasia in Barrett's Esophagus (BE) from neoplasia in vivo remains difficult as both tissue types can be flat and indistinguishable with white light imaging alone. As a result, a modality that highlights glandular architecture would be useful to discriminate neoplasia from benign epithelium in the distal esophagus. VFI is a novel technique that uses an exogenous topical fluorescent contrast agent to delineate high grade dysplasia and cancer from benign epithelium. Specifically, the fluorescent images provide spatial resolution of 50 to 100 μm and a field of view up to 2.5 cm, allowing endoscopists to visualize glandular morphology. Upon excitation, classic Barrett's metaplasia appears as continuous, evenly-spaced glands and an overall homogenous morphology; in contrast, neoplastic tissue appears crowded with complete obliteration of the glandular framework. Here we provide an overview of the instrumentation and enumerate the protocol of this new technique. While VFI affords a gastroenterologist with the glandular architecture of suspicious tissue, cellular dysplasia cannot be resolved with this modality. As such, one cannot morphologically distinguish Barrett's metaplasia from BE with Low-Grade Dysplasia via this imaging modality. By trading off a decrease in resolution with a greater field of view, this imaging system can be used at the very least as a red-flag imaging device to target and biopsy suspicious lesions; yet, if the accuracy measures are promising, VFI may become the standard imaging technique for the diagnosis of neoplasia (defined as either high grade dysplasia or cancer) in the distal esophagus.
authors.affiliation: Department of Gastroenterology, Icahn School of Medicine at Mount Sinai.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Perl
authors.affiliation: Department of Gastroenterology, Icahn School of Medicine at Mount Sinai.
authors.forename: Neil
authors.initials: N
authors.lastname: Parikh
authors.affiliation: Department of Gastroenterology, Icahn School of Medicine at Mount Sinai.
authors.forename: Shannon
authors.initials: S
authors.lastname: Chang
authors.affiliation: Department of Gastroenterology, Icahn School of Medicine at Mount Sinai.
authors.forename: Paul
authors.initials: P
authors.lastname: Peng
authors.affiliation: Department of Bioengineering, Rice University.
authors.forename: Nadhi
authors.initials: N
authors.lastname: Thekkek
authors.affiliation: Department of Gastroenterology, Icahn School of Medicine at Mount Sinai.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Department of Pathology, Icahn School of Medicine at Mount Sinai.
authors.forename: Alexandros D
authors.initials: AD
authors.lastname: Polydorides
authors.affiliation: Department of Gastroenterology, Icahn School of Medicine at Mount Sinai.
authors.forename: Josephine
authors.initials: J
authors.lastname: Mitcham
authors.affiliation: Department of Bioengineering, Rice University.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Richards-Kortum
authors.affiliation: Department of Gastroenterology, Icahn School of Medicine at Mount Sinai; sharmila.anandasabapathy@mountsinai.org.
authors.forename: Sharmila
authors.initials: S
authors.lastname: Anandasabapathy
mesh_terms: D001471:Barrett Esophagus / Q000175:diagnosis* / Q000473:pathology; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D061848:Optical Imaging / Q000379:methods*