Comprehensive imaging of gastroesophageal biopsy samples by spectrally encoded confocal microscopy

• Published in: Gastrointestinal endoscopy 2010-01, Vol.71 (1), p.35-43
• Main Authors: Kang, DongKyun, PhD, Suter, Melissa J., PhD, Boudoux, Caroline, PhD, Yoo, Hongki, PhD, Yachimski, Patrick S., MD, Puricelli, William P., RN, Nishioka, Norman S., MD, Mino-Kenudson, Mari, MD, Lauwers, Gregory Y., MD, Bouma, Brett E., PhD, Tearney, Guillermo J., MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Biopsy; Digestive system. Abdomen; Endoscopy; Endoscopy, Digestive System; Esophagogastric Junction - pathology; Esophagus - pathology; Feasibility Studies; Female; Gastric Mucosa - pathology; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Microscopy, Confocal - methods; Middle Aged; Stomach - pathology
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2009.08.026

Background Spectrally encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technique that has the potential to be used for acquiring comprehensive images of the entire distal esophagus endoscopically with subcellular resolution. Objective The goal of this study was to demonstrate large-area SECM in upper GI tissues and to determine whether the images contain microstructural information that is useful for pathologic diagnosis. Design A feasibility study. Setting Gastrointestinal Unit, Massachusetts General Hospital. Patients Fifty biopsy samples from 36 patients undergoing routine EGD were imaged by SECM, in their entirety, immediately after their removal. Results The microstructure seen in the SECM images was similar to that seen by histopathology. Gastric cardia mucosa was clearly differentiated from squamous mucosa. Gastric fundic/body type mucosa showed more tightly packed glands than gastric cardia mucosa. Fundic gland polyps showed cystically dilated glands lined with cuboidal epithelium. The presence of intraepithelial eosinophils was detected with the cells demonstrating a characteristic bilobed nucleus. Specialized intestinal metaplasia was identified by columnar epithelium and the presence of goblet cells. Barrett's esophagus (BE) with dysplasia was differentiated from specialized intestinal metaplasia by the loss of nuclear polarity and disorganized glandular architecture. Limitations Ex vivo, descriptive study. Conclusions Large-area SECM images of gastroesophageal biopsy samples enabled the visualization of both subcellular and architectural features of various upper GI mucosal types and were similar to the corresponding histopathologic slides. These results suggest that the development of an endoscopic SECM probe is merited.