title: Multimodal endoscope can quantify wide-field fluorescence detection of Barrett's neoplasia.
abstract: OBJECTIVE
  To demonstrate the clinical use of a multimodal endoscope with a targeted fluorescently labeled peptide for quantitative detection of Barrett's neoplasia.
  
  
  METHODS
  We studied 50 patients with Barrett's esophagus using a prototype multimodal endoscope with a fluorescently labeled peptide. Co-registered fluorescence and reflectance images were converted to ratios to correct for differences in distance and geometry over the image field of view. The ratio images were segmented using a unique threshold that maximized the variance between high and low intensities to localize regions of high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC).
  
  
  RESULTS
  Early neoplasia (HGD and EAC) was identified with 94 % specificity and 96 % positive predictive value at a threshold of 1.49. The mean results for HGD and EAC were significantly greater than those for squamous/Barrett's esophagus and low grade dysplasia by one-way analysis of variance (ANOVA). The receiver operator characteristic curve for detection of early neoplasia had an area under the curve of 0.884. No adverse events associated with the endoscope or peptide were found.
  
  
  CONCLUSIONS
  A multimodal endoscope can quantify fluorescence images from targeted peptides to localize early Barrett's neoplasia. (ClinicalTrials.gov number NCT01630798.).
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Bishnu P
authors.initials: BP
authors.lastname: Joshi
authors.affiliation: Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Xiyu
authors.initials: X
authors.lastname: Duan
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kwon
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Piraka
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
authors.affiliation: Department of General Surgery, First Affiliated Hospital, Medical School of Xi'an Jiaotong University, People's Republic of China.
authors.forename: Shaoying
authors.initials: S
authors.lastname: Lu
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Rabinsky
authors.affiliation: Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Beer
authors.affiliation: Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Henry D
authors.initials: HD
authors.lastname: Appelman
authors.affiliation: Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Owens
authors.affiliation: University of Michigan Cancer Center, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Rork
authors.initials: R
authors.lastname: Kuick
authors.affiliation: Olympus Medical Systems Corp., Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Doguchi
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: D Kim
authors.initials: DK
authors.lastname: Turgeon
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Wang
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis*; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods*; D020776:Endoscopes, Gastrointestinal; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005453:Fluorescence; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000295:instrumentation*; D011230:Precancerous Conditions; D015203:Reproducibility of Results