Abstract
Background and study aims Precise staging in T1 esophageal adenocarcinoma (EAC) is critical in determining candidacy
for curative endoscopic resection. High-frequency endoscopic ultrasound (EUS) has
demonstrated suboptimal accuracy in T1 EAC staging due to insufficient spatial resolution.
Volumetric laser endomicroscopy (VLE) allows for high-resolution wide-field visualization
of the esophageal microstructure. We aimed to investigate the role of VLE in staging
T1 EAC.
Patients and methods Patients undergoing endoscopic mucosal resection (EMR) were prospectively enrolled
and only T1 EAC cases were included. EMR specimens were imaged using second-generation
VLE immediately after resection. VLE images were analyzed for signal intensity by
depth and signal attenuation (dB/mm) in both cross-sectional and en-face orientation.
A decision tree model was constructed to combine measured VLE parameters and delineate
diagnostic thresholds.
Results Thirty EMR scans were obtained – 15 T1a specimens from 9 patients and 15 T1b specimens
from 11 patients. T1b specimen VLE scans exhibited higher signal intensity (P < 0.0001) and higher signal attenuation compared to T1a specimens (P = 0.03). A combination of signal attenuation and signal intensity at 150 µm depth
yielded optimal diagnostic thresholds and an area under the curve (AUC) of 0.77. VLE
signal attenuation was significantly associated with grade of differentiation, irrespective
of EAC stage.
Conclusions VLE signal intensity and signal attenuation are quantitatively distinct in
T1a and T1b EAC and associated with grade of differentiation. This is the first study
examining
the role of VLE for staging of T1 EAC and demonstrates promising diagnostic performance.
With further in vivo validation, VLE may serve a role in staging superficial EAC.
