title: In vivo risk analysis of pancreatic cancer through optical characterization of duodenal mucosa.
abstract: OBJECTIVE
  To reduce pancreatic cancer mortality, a paradigm shift in cancer screening is needed. Our group pioneered the use of low-coherence enhanced backscattering (LEBS) spectroscopy to predict the presence of pancreatic cancer by interrogating the duodenal mucosa. A previous ex vivo study (n = 203) demonstrated excellent diagnostic potential: sensitivity, 95%; specificity, 71%; and accuracy, 85%. The objective of the current case-control study was to evaluate this approach in vivo.
  
  
  METHODS
  We developed a novel endoscope-compatible fiber-optic probe to measure LEBS in the periampullary duodenum of 41 patients undergoing upper endoscopy. This approach enables minimally invasive detection of the ultrastructural consequences of pancreatic field carcinogenesis.
  
  
  RESULTS
  The LEBS parameters and optical properties were significantly altered in patients harboring adenocarcinomas (including early-stage) throughout the pancreas relative to healthy controls. Test performance characteristics were excellent with sensitivity = 78%, specificity = 85%, and accuracy = 81%. Moreover, the LEBS prediction rule was not confounded by patients' demographics.
  
  
  CONCLUSIONS
  We demonstrate the feasibility of in vivo measurement of histologically normal duodenal mucosa to predict the presence of adenocarcinoma throughout the pancreas. This represents the next step in establishing duodenal LEBS analysis as a prescreening technique that identifies clinically asymptomatic patients who are at elevated risk of PC.
authors.affiliation: From the *Department of Biomedical Engineering, Northwestern University; †Department of Internal Medicine, NorthShore University HealthSystems, Evanston; ‡Center for Endoscopic Research and Therapeutics, University of Chicago Medicine, Chicago, IL; and §Department of Gastroenterology, Boston Medical Center, Boston, MA.
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Mutyal
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Radosevich
authors.forename: Shailesh
authors.initials: S
authors.lastname: Bajaj
authors.forename: Vani
authors.initials: V
authors.lastname: Konda
authors.forename: Uzma D
authors.initials: UD
authors.lastname: Siddiqui
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldberg
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Rogers
authors.forename: Bradley
authors.initials: B
authors.lastname: Gould
authors.forename: Adam
authors.initials: A
authors.lastname: Eshein
authors.forename: Sudeep
authors.initials: S
authors.lastname: Upadhye
authors.forename: Ann
authors.initials: A
authors.lastname: Koons
authors.forename: Mariano
authors.initials: M
authors.lastname: Gonzalez-Haba Ruiz
authors.forename: Hemant K
authors.initials: HK
authors.lastname: Roy
authors.forename: Vadim
authors.initials: V
authors.lastname: Backman
mesh_terms: D000230:Adenocarcinoma / Q000648:ultrastructure*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D020698:Duodenoscopes; D004384:Duodenoscopy / Q000295:instrumentation / Q000379:methods*; D004386:Duodenum / Q000648:ultrastructure*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000648:ultrastructure*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000648:ultrastructure*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013057:Spectrum Analysis