title: A tablet-interfaced high-resolution microendoscope with automated image interpretation for real-time evaluation of esophageal squamous cell neoplasia.
abstract: OBJECTIVE
  In recent years high-resolution microendoscopy (HRME) has shown potential to improve screening for esophageal squamous cell neoplasia. Furthering its utility in a clinical setting, especially in lower-resource settings, could be accomplished by reducing the size and cost of the system as well as incorporating the ability of real-time, objective feedback. This article describes a tablet-interfaced HRME with fully automated, real-time image analysis.
  
  
  METHODS
  The performance of the tablet-interfaced HRME was assessed by acquiring images from the oral mucosa in a normal volunteer. An automated, real-time analysis algorithm was developed and evaluated using training, test, and validation images from a previous in vivo study of 177 patients referred for screening or surveillance endoscopy in China. The algorithm was then implemented in a tablet HRME that was used to obtain and analyze images from esophageal tissue in 3 patients. Images were displayed alongside the probability that the imaged region was neoplastic.
  
  
  RESULTS
  The tablet-interfaced HRME demonstrated comparable imaging performance at a lower cost compared with first-generation laptop-interfaced HRME systems. In a post-hoc quantitative analysis, the algorithm identified neoplasia with a sensitivity and specificity of 95% and 91%, respectively, in the validation set compared with 84% and 95% achieved in the original study.
  
  
  CONCLUSIONS
  The tablet-based HRME is a low-cost tool that provides quantitative diagnostic information to the endoscopist in real time. This could be especially beneficial in lower-resource settings for operators with less experience interpreting HRME images.
authors.affiliation: Department of Bioengineering, Rice University, Houston, Texas, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Quang
authors.affiliation: Department of Bioengineering, Rice University, Houston, Texas, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Schwarz
authors.affiliation: Department of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
authors.forename: Sanford M
authors.initials: SM
authors.lastname: Dawsey
authors.affiliation: Department of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Mimi C
authors.initials: MC
authors.lastname: Tan
authors.affiliation: Department of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Kalpesh
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Endoscopy, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Xinying
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Endoscopy, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Guiqi
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Gastrointestinal Medicine, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Medicine, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Sharmila
authors.initials: S
authors.lastname: Anandasabapathy
authors.affiliation: Department of Bioengineering, Rice University, Houston, Texas, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Richards-Kortum
mesh_terms: D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging*; D034201:Computers, Handheld; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging*; D004945:Esophagoscopy / Q000295:instrumentation*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D000069416:Intravital Microscopy / Q000295:instrumentation*; D063731:Mobile Applications; D012680:Sensitivity and Specificity