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  • Novel Device May Aid Earlier Detection of Esophageal Cancer

    German researchers say a new device may surpass the gold standard in diagnosing esophageal cancer. By Mike Bassett

    July 1, 2017

    Because most patients with suspected esophageal cancer are not diagnosed untilthe disease has reached an advanced stage, early detection has become a critical goal among researchers.

    To that end, a device that may facilitate early diagnosis and staging of esophageal cancer — hybrid optical and optoacoustic endoscope for esophageal tracking (ESOTRAC) — is being developed by researchers at the Institute of Biological and Medical Imaging (IBMI) at Helmholtz Zentrum München and Technical University of Munich in Germany.

    ESOTRAC has been awarded €4 million from Horizon 2020, the European Union framework program for research and innovation.

    The current gold standard for diagnosing esophageal cancer is high-definition white-light endoscopy (HD-WLE) with biopsy, while endoscopic ultrasound, as well as CT and MRI, is used for staging. PET has also become a mainstay in the staging of esophageal cancer, particularly in terms of metastatic disease.

    But HD-WLE, which employs a videoscopic approach based on human vision, is significantly limited in terms of sensitivity and specificity, said Vasilis Ntziachristos, MSc, PhD, ESOTRAC coordinator, director of the IBMI at Helmholtz Zentrum München and professor and chair of biological imaging at the Technical University of Munich.

    “Human vision cannot identify early signs of disease, small foci or sub-surface tissue alterations, which means that patients who undergo surveillance endoscopies must be further treated with random four-quadrant biopsies,” Dr. Ntziachristos said.

    “The current random biopsy approach has an inherently high chance of sampling error, resulting in a remaining detection miss rate of up to 57 percent for the combined HD-WLE/random biopsy approach,” Dr. Ntziachristos said. “These limitations have led to a search for alternative endoscopic techniques.”

    Device May Surpass Gold Standard

    The objective of the ESOTRAC research project is to develop an optical endoscope based on optoacoustic technology that will non-invasively provide 3-D visualization of the morphological and pathophysiological features of the wall of the esophagus.

    “Using multi-spectral optoacoustic tomography technology, the new scope will be able to quantitatively resolve inflammation, tissue blood oxygen saturation and vascularization without using contrast agents and in high-resolution,” Dr. Ntziachristos said. “Furthermore, the ESOTRAC scope will be engineered for fast 3-D imaging of the entire esophageal tract.”

    Therefore, he says, it offers a more accurate visualization for surveillance applications compared to the current gold standard.

    Researchers plan to integrate the ESOTRAC scope’s multi-spectral optoacoustic tomography with optical coherence tomography (OCT), combining two promising optical imaging methods in one modality, operating on complementary optical contrast.

    The ESOTRAC scope is able to sense esophageal tissue alterations occurring earlier in esophageal cancer progression, at a microscopic scale, before the development of large protruding lesions from the vessel wall that are typically captured by HD-WLE, Dr. Ntziachristos said.

    Promise in Depth Penetration

    Regarding tumor staging, esophageal cancer and colon cancer are very similar in terms of the relationship of the tumor to the muscular layers of the organ of interest, said Alexander Guimaraes, MD, PhD, co-chair of the RSNA Oncologic Imaging and Therapies Task Force and the recipient of two RSNA research grants.

    But the challenges involved with esophageal cancer are different than those associated with colon cancer, said Dr. Guimaraes, associate professor in the Diagnostic Radiology Department at the Oregon Health and Science University.

    “The organ is smaller and is also surrounded by the lung,” he said. “And while we can image the esophagus well, we don’t seem to be able to do as good of a job determining the small size of tumors and their relationship to these muscle layers with MRI.”

    “Optical coherence tomography and ultrasound have done adequately — both in rectal and esophageal cancer,” he continued. “But this device shows promise in seeing the relationship of the tumor well with regard to the muscular layers. And because of its depth penetration, it may be able to answer questions of nodal involvement better than existing endoscopic ultrasound techniques.”

    The device will have direct implications for imaging the entire gastrointestinal tract, Dr. Ntziachristos said. The researchers also envision applications for gastric and colon cancer.

    ESOTRAC comprises top physicians and engineers from nine different European institutions in five countries.