title: Quantitative analysis of high-resolution microendoscopic images for diagnosis of esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  High-resolution microendoscopy is an optical imaging technique with the potential to improve the accuracy of endoscopic screening for esophageal squamous neoplasia. Although these microscopic images can be interpreted readily by trained personnel, quantitative image analysis software could facilitate the use of this technology in low-resource settings. In this study, we developed and evaluated quantitative image analysis criteria for the evaluation of neoplastic and non-neoplastic squamous esophageal mucosa.
  
  
  METHODS
  We performed an image analysis of 177 patients undergoing standard upper endoscopy for screening or surveillance of esophageal squamous neoplasia, using high-resolution microendoscopy, at 2 hospitals in China and at 1 hospital in the United States from May 2010 to October 2012. Biopsy specimens were collected from imaged sites (n = 375), and a consensus diagnosis was provided by 2 expert gastrointestinal pathologists and used as the standard.
  
  
  RESULTS
  Quantitative information from the high-resolution images was used to develop an algorithm to identify high-grade squamous dysplasia or invasive squamous cell cancer, based on histopathology findings. Optimal performance was obtained using the mean nuclear area as the basis for classification, resulting in sensitivities and specificities of 93% and 92% in the training set, 87% and 97% in the test set, and 84% and 95% in an independent validation set, respectively.
  
  
  CONCLUSIONS
  High-resolution microendoscopy with quantitative image analysis can aid in the identification of esophageal squamous neoplasia. Use of software-based image guides may overcome issues of training and expertise in low-resource settings, allowing for widespread use of these optical biopsy technologies.
authors: Department of Bioengineering, Rice University, Houston, Texas.
authors: Dongsuk
authors: D
authors: Shin
authors: Division of Gastroenterology, The Mount Sinai Medical Center, New York, New York.
authors: Marion-Anna
authors: MA
authors: Protano
authors: Department of Pathology, The Mount Sinai Medical Center, New York, New York.
authors: Alexandros D
authors: AD
authors: Polydorides
authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors: Sanford M
authors: SM
authors: Dawsey
authors: Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey.
authors: Mark C
authors: MC
authors: Pierce
authors: Division of Gastroenterology, The Mount Sinai Medical Center, New York, New York.
authors: Michelle Kang
authors: MK
authors: Kim
authors: Department of Bioengineering, Rice University, Houston, Texas.
authors: Richard A
authors: RA
authors: Schwarz
authors: Department of Bioengineering, Rice University, Houston, Texas.
authors: Timothy
authors: T
authors: Quang
authors: Division of Gastroenterology, The Mount Sinai Medical Center, New York, New York.
authors: Neil
authors: N
authors: Parikh
authors: Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Manoop S
authors: MS
authors: Bhutani
authors: Department of Gastrointestinal Medicine, The First Hospital of Jilin University, Changchun, Jilin, China.
authors: Fan
authors: F
authors: Zhang
authors: Department of Endoscopy, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China.
authors: Guiqi
authors: G
authors: Wang
authors: Department of Pathology, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China.
authors: Liyan
authors: L
authors: Xue
authors: Department of Gastrointestinal Medicine, The First Hospital of Jilin University, Changchun, Jilin, China.
authors: Xueshan
authors: X
authors: Wang
authors: Department of Gastrointestinal Medicine, The First Hospital of Jilin University, Changchun, Jilin, China.
authors: Hong
authors: H
authors: Xu
authors: Division of Gastroenterology, The Mount Sinai Medical Center, New York, New York.
authors: Sharmila
authors: S
authors: Anandasabapathy
authors: Department of Bioengineering, Rice University, Houston, Texas. Electronic address: rkortum@rice.edu.
authors: Rebecca R
authors: RR
authors: Richards-Kortum
mesh_terms: D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology*; D002681:China; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D000077277:Esophageal Squamous Cell Carcinoma; D004945:Esophagoscopy / Q000379:methods*; D006761:Hospitals; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008403:Mass Screening / Q000379:methods; D014481:United States
keywords: Diagnostic; Esophageal Cancer; HRME; Quantitative Diagnosis