Development of Advanced Imaging and Molecular Imaging for Barrett’s Neoplasia

Abstract

Barrett esophagus (BE) is a precursor to a life-threatening esophageal adenocarcinoma (EAC). Surveillance endoscopy with random biopsies is recommended for early intervention against EAC, but its adherence in the clinical setting is poor. Dysplastic lesions with flat architecture and patchy distribution in BE are hardly detected by high-resolution endoscopy, and the surveillance protocol entails issues of time and labor and suboptimal interobserver agreement for diagnosing dysplasia. Therefore, the development of advanced imaging technologies is necessary for Barrett’s surveillance. Recently, non-endoscopic or endoscopic technologies, such as cytosponge, endocytoscopy, confocal laser endomicroscopy, autofluorescence imaging, and optical coherence tomography/volumetric laser endomicroscopy, were developed, but most of them are not clinically available due to the limited view field, expense of the equipment, and significant time for the learning curve. Another strategy is focused on the development of molecular biomarkers, which are also not ready to use. However, a combination of advanced imaging techniques together with specific biomarkers is expected to identify morphological abnormalities and biological disorders at an early stage in the surveillance. Here, we review recent developments in advanced imaging and molecular imaging for Barrett’s neoplasia. Further developments in multiple biomarker panels specific for Barrett’s HGD/EAC include wide-field imaging systems for targeting ‘red flags’, a high-resolution imaging system for optical biopsy, and a computer-aided diagnosis system with artificial intelligence, all of which enable a real-time and accurate diagnosis of dysplastic BE in Barrett’s surveillance and provide information for precision medicine.

Predicting the risk of developing low‐grade dysplasia in patients with Barrett's esophagus without dysplasia

“…7 In addition, computer-aided diagnosis systems based on M-NBI have demonstrated excellent results in terms of accuracy, sensitivity, and specificity, but evidence has not yet been established at a level that can be applied in actual clinical practice. 7 There are also reports showing the effectiveness of endocytoscopy, confocal laser endoscopy, optical coherence tomography, and volumetric laser endomicroscopy; however, they have not been widely used because of the narrow range of imaging capabilities, the price of equipment, and the length of time required to master the techniques. 7 The biggest problem is that there is no certain answer as to which modality, including imageenhanced endoscopy, is the most effective method for detecting Barrett's epithelial dysplasia.…”

“…7 There are also reports showing the effectiveness of endocytoscopy, confocal laser endoscopy, optical coherence tomography, and volumetric laser endomicroscopy; however, they have not been widely used because of the narrow range of imaging capabilities, the price of equipment, and the length of time required to master the techniques. 7 The biggest problem is that there is no certain answer as to which modality, including imageenhanced endoscopy, is the most effective method for detecting Barrett's epithelial dysplasia. Therefore, at this time, the ACG guideline recommends that LGD should be diagnosed histologically using random biopsy of Barrett's epithelium according to the Seattle protocol 8 under surveillance endoscopy instead of optically.…”

“…If the presence or absence of LGD can be accurately determined using endoscopic findings alone, the frequency of biopsies can be reduced. A recent review article summarized that magnified narrow‐band imaging (M‐NBI) is useful in the detection of dysplasia within BE 7 . In addition, computer‐aided diagnosis systems based on M‐NBI have demonstrated excellent results in terms of accuracy, sensitivity, and specificity, but evidence has not yet been established at a level that can be applied in actual clinical practice 7 .…”

“…A recent review article summarized that magnified narrow‐band imaging (M‐NBI) is useful in the detection of dysplasia within BE 7 . In addition, computer‐aided diagnosis systems based on M‐NBI have demonstrated excellent results in terms of accuracy, sensitivity, and specificity, but evidence has not yet been established at a level that can be applied in actual clinical practice 7 . There are also reports showing the effectiveness of endocytoscopy, confocal laser endoscopy, optical coherence tomography, and volumetric laser endomicroscopy; however, they have not been widely used because of the narrow range of imaging capabilities, the price of equipment, and the length of time required to master the techniques 7 .…”