Feature Of The Week 10/08/2018: Clinical Utility of Ultrahigh-Speed Endoscopic Optical Coherence Tomography in Gastroenterology
Barrett’s esophagus (BE) surveillance is limited by biopsy sampling error. Optical coherence tomography (OCT) enables microscopic resolution, high speed, volumetric imaging and is commercially available as volumetric laser endomicroscopy (VLE, NinePoint Medical). Studies investigated cross-sectional OCT dysplasia features, including a diagnostic algorithm (VLE-DA), however, many VLE studies used ex vivo specimens due to challenges in registering biopsy with OCT. We previously demonstrated ultrahigh-speed endoscopic OCT >10x faster than commercial instruments, enabling depth-resolved en face and cross-sectional imaging. This study investigated volumetric en face and cross-sectional OCT for identifying neoplasia. 74 OCT datasets with correlated biopsy/endoscopic mucosal resection histology (49 non-dysplastic BE (NDBE), 25 neoplasia) were obtained from 14 BE patients with history of dysplasia and 30 with NDBE in vivo. The associations between irregular mucosal patterns on en face OCT, and absence of mucosal layering, surface signal>subsurface, and >5 atypical glands on cross-sectional OCT versus histology and treatment history were assessed by 3 blinded readers. Atypical glands under irregular mucosal patterns occurred in 75% of neoplasia (96% of treatment-naïve neoplasia) versus 30% of NDBE datasets (43% of short and 18% of long-segment NDBE). Mucosal layering was absent in 35% of neoplasia and 53% of NDBE datasets, and surface signal>subsurface in 29% of neoplasia and 30% of NDBE datasets. Findings suggest that atypical glands under irregular mucosal patterns are associated with neoplasia and pathogenesis.
For more information see recent Article1, Article2, and Article3. Courtesy Osman O. Ahsen from the Massachusetts Institute of Technology.