Multispectral scanning during endoscopy guides biopsy of dysplasia in Barrett's esophagus

Most cases of esophageal cancer can be prevented if detected early at the precancerous high-grade dysplasia stage in patients presenting with Barrett's esophagus, a condition that almost always precedes this form of cancer. Here, Qiu and colleagues have developed a multispectral imaging system that uses endoscopic polarized scanning spectroscopy to perform rapid optical scanning and imaging of the entire esophageal surface, providing a diagnosis in near real time. Esophageal cancer is increasing in frequency in the United States faster than any other cancer. Barrett's esophagus, an otherwise benign complication of esophageal reflux, affects approximately three million Americans and precedes almost all cases of esophageal cancer. If detected as high-grade dysplasia (HGD), most esophageal cancers can be prevented. Standard-of-care screening for dysplasia uses visual endoscopy and a prescribed pattern of biopsy. This procedure, in which a tiny fraction of the affected tissue is selected for pathological examination, has a low probability of detection because dysplasia is highly focal and visually indistinguishable. We developed a system called endoscopic polarized scanning spectroscopy (EPSS), which performs rapid optical scanning and multispectral imaging of the entire esophageal surface and provides diagnoses in near real time. By detecting and mapping suspicious sites, guided biopsy of invisible, precancerous dysplasia becomes practicable. Here we report the development of EPSS and its application in several clinical cases, one of which merits special consideration.