Endoscopic Ultraviolet-Induced Autofluorescence Spectroscopy of the Esophagus: Tissue Characterization and Potential for Early Cancer Diagnosis

Background and Study Aims: Endoscopic identification of dysplasia and early carcinoma of the esophagus is difficult and is currently done through random pinch biopsies. This study assesses the potential of ultraviolet-induced autofluorescence spectroscopy for early diagnosis with special focus on Barrett's esophagus.

Patients and Methods: Measurements were performed on 24 patients using 330 nm light excitation. The determination of the spectral distribution typical of each histological tissue type was done using three fluorescence intensity ratios: R₁ = I_390nm/I_450nm; R₂ = I_550nm/I_450nm; R₃ = I_390nm/I_550nm.

Results: The spectral distribution of normal esophageal mucosa and specialized columnar Barrett's mucosa were similar. A strong modification of the spectral distribution was observed for high grade dysplasia and intramucosal carcinoma. Statistical analysis indicated that the spectral shape modification associated with neoplastic transformation was greater than intra- and interpatient spectral variations. These results allow the determination of discriminating criteria based on ratios R₁ and R₃. Using ratio R₃, the spectroscopy-based diagnosis differentiated neoplastic tissue from normal esophageal mucosa and specialized columnar Barrett's mucosa with a sensitivity and specificity of 86 % and 95 %, respectively.

Conclusions: The use of ultraviolet autofluorescence spectroscopy should improve the diagnostic yield of standard endoscopy in patients with Barrett's esophagus.

Résumé

Contexte et objectifs de l'étude: L'identification endoscopique des dysplasies et des carcinomes précoces de l'oesophage est difficile et effectuée au moyen de biopsies étagées systématiques. Cette étude évalue la capacité de la spectroscopie d'autofluorescence UV à détecter ces lésions précoces avec un intérêt particulier pour l'endobrachyoesophage (EBO).

Patients et méthodes: Les mesures ont porté sur 24 patients en utilisant une excitation lumineuse à 330 nm. La détermination de la distribution spectrale caractéristique de chaque type histologique est faite en utilisant les trois rapports d'intensité de fluorescence. R₁ = I_390nm/I_450nm; R₂ = I_550nm/ I_450nm; R₃ = I_390nm/I_550nm.

Résultats: Les distributions spectrales relatives à la muqueuse malpighienne oesophagienne saine et à la muqueuse spécialisée de l'EBO non dysplasique sont similaires. La présence d'une dysplasie de haut grade ou d'un carcinome intramuqueux se traduit par une modification de la distribution spectrale. L'analyse statistique montre que la modification spectrale associée à la transformation néoplasique est plus forte que les variations intra- et interpatients. Ces résultats ont permis la détermination de critères de discrimination fondés sur les rapports R₁ et R₃. L'utilisation du rapport R₃ permet de différencier le tissue néoplasique de la muqueuse malpighienne et de la muqueuse de Barrett avec une sensibilité de 86% et une spécificité de 95%.

Conclusion: La spectroscopie d'autofluorescence UV, en orientant les biopsies, devrait accroître l'efficacité diagnostique de l'endoscopie conventionnelle.

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