New Methods & Materials
Autofluorescence endoscopy: Feasibility of detection of GI neoplasms unapparent to white light endoscopy with an evolving technology

https://doi.org/10.1067/mge.2001.114419Get rights and content

Abstract

Background: Case studies are presented of fluorescence endoscopy in the upper and lower GI tract to illustrate the ability to detect early-stage lesions that were not observable with white light endoscopy or those in which the assessment of the stage or extension of the lesion were equivocal. Methods: A new fluorescence imaging system was used in which blue light excites the naturally-occurring fluorescence of tissues (autofluorescence). The system produces real-time, false-color images that combine green and red fluorescence intensities. In general, abnormal lesions are seen to have an increase in the red-to-green fluorescence intensity compared with surrounding tissue. This system was evaluated in patients at 4 participating institutions, concurrently with standard white light endoscopy, with or without dye staining. Results: Selected cases are presented in which fluorescence imaging identified specific lesions including focal high-grade dysplasia in Barrett's mucosa, signet ring carcinoma of the stomach, and flat adenoma in the colon. Conclusions: The capability of autofluorescence endoscopy to detect the presence and extent of occult malignant and premalignant GI lesions has been demonstrated. The future development and evaluation of this technology are discussed.

Section snippets

LIFE II instrument system

The LIFE II system (Fig. 2) operates in 2 modes: fluorescence and conventional white light imaging.

. Schematic diagram of the LIFE-II system showing overall system and details of the special camera head with a white-light and 2 fluorescence cameras.

The camera head that enables this weighs approximately 500 g and attaches to the eyepiece of a standard Olympus fiberoptic endoscope (Olympus Optical Co. Ltd., Tokyo, Japan). A fiberoptic endoscope is currently required because image sensors are not

Results

To date, LIFE imaging has been performed in several hundred patients, and detailed analyses of specific subgroups are in progress.18 Here, clinical cases will be presented that illustrate the capabilities of fluorescence imaging in relation to WLE in the esophagus, stomach, and colon. All lesions described are biopsy-proven. The color contrast in the still images presented is much inferior to that of the real-time display in which the moving field-of-view and angle of illumination are essential

Discussion

These examples indicate that fluorescence imaging can detect lesions that are not evident by WLE and can correctly classify such lesions as benign, malignant, or dysplastic. The extent to which LIFE increases diagnostic accuracy must now be quantified in randomized clinical trials and the potential roles for this technology in each organ must be clearly established. In the esophagus, early-stage malignant or dysplastic lesions are often difficult to detect by WLE, although some features of

Disclosure

This work was supported by Xillix Technologies Corp., B.C., Canada and Olympus Optical Co. Ltd., Tokyo, Japan. Work in Toronto was also supported by Photonics Research Ontario and the Medical Research Council of Canada.

R. Cline is an employee of Xillix Corp., and B. Wilson serves as Scientific Advisor. None of the other authors have a relationship to this company.

Acknowledgements

The following individuals contributed to the work presented: M. van Ierland-van Leeuwen, MD (Amsterdam); A. Nimihisa, MD, and A. Ohkawa, MD (Tokyo); M. Cirocco, RN, S. Hassaram, MD, L. Lilge, PhD, G. Sandha, MD, and J. Kost, MS (Toronto).

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Reprint requests: Brian C. Wilson, PhD, Ontario Cancer Institute, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.

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