State of the art in advanced endoscopic imaging for the detection and evaluation of dysplasia and early cancer of the gastrointestinal tract

Figures & data

Figure 1 Goal-oriented classification of image-enhancement, magnifying, and microscopic techniques currently available and approved for clinical use.

Note: i-Scan is manufactured by Pentax.
Abbreviations: AFI, autofluorescence imaging; CLE, confocal laser endomicroscopy; EC, endocytoscopy; FICE, Fuji intelligent chromoendoscopy; HDE, high-definition endoscopy; NBI, narrow-band imaging.

Figure 2 (A) Conventional endoscopic view of Barrett’s esophagus with concomitant esophagitis. (B) Positive staining of Barrett’s epithelium after absorption chromoendoscopy with methylene blue dye solution (1%, 10 mL). (C) Villous cerebroid pits with finger-like projections seen with magnification endoscopy (pattern 5 according to Endo’s classification). (D) Histological section of (C) showing intestinal metaplasia with glands of different size and shape and numerous goblet cells.

Note: Images provided courtesy of Dr Sergio Coda and Professor Paolo Trentino, University of Rome “La Sapienza,” Italy.

Figure 3 Example images of areas of suspected early cancers of the gastric antrum (A and B) and cardia (C and D), imaged using standard WLE (A and C) and NBI (B and D) to demonstrate the contrast enhancement provided by NBI.

Note: Images provided courtesy of Professor Paolo Trentino, University of Rome “La Sapienza,” Italy.
Abbreviations: NBI, narrow-band imaging; WLE, white-light endoscopy.

Figure 4 Schematic diagram showing the difference between a standard RGB filter (A) and the NBI filter (B).

Notes: Compared with the full range of white-light illumination, the filtered light penetrates the tissue less, highlighting the superficial details of the mucosa. Additionally, the filtered centered wavelengths fall within hemoglobin absorption bands (inset of B), and this leads to a higher contrast for vascular structures. The inset of B is reproduced from Zonios G, Perelman LT, Backman V, Manoharan R, Fitzmaurice M, Van Dam J, Feld MS. Diffuse reflectance spectroscopy of human adenomatous colon polyps in vivo. Appl Opt. 1999;38(31):6628–6637.⁵⁷ Copyright © 1999 Optical Society of America.
Abbreviations: CCD, charge-coupled device; NBI, narrow-band imaging; RGB, red, green, and blue.

Figure 5 Example images of a suspected early cancer of the gastric antrum, imaged using standard WLE (A) and AFI (B), to demonstrate the contrast enhancement provided by AFI (Olympus Corporation, Tokyo, Japan).

Notes: Images provided courtesy of Dr Chizu Yokoi, National Center for Global Health and Medicine, Tokyo, Japan.
Abbreviations: AFI, autofluorescence imaging; WLE, white-light endoscopy.

Figure 6 Schematic diagram of confocal microscopy principles.

Notes: The blue rays (pre- and post-objective and excitation filter) indicate the laser illumination delivered to the tissue sample. The fluorescence emitted from a tissue layer in focus (orange rays) will pass through the pinhole and will be detected. The majority of the fluorescence emitted from tissue layers out of focus (red and green rays) will be rejected. Illumination and collection therefore occur in the same focal plane (ie, they are confocal). Figure adapted with permission from Kumar S. Development of Multidimensional Fluorescence Imaging Technology with a View towards the Imaging of Signalling at the Immunological Synapse [doctoral thesis]. London: Chemical Biology Centre, Department of Chemistry, Imperial College London; 2010.¹⁵¹
Abbreviation: PMT, photomultiplier tube.

ZoniosGPerelmanLTBackmanVManoharanRFitzmauriceMVan DamJFeldMSDiffuse reflectance spectroscopy of human adenomatous colon polyps in vivoAppl Opt199938316628663718324198

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KumarSDevelopment of Multidimensional Fluorescence Imaging Technology with a View towards the Imaging of Signalling at the Immunological Synapse [doctoral thesis]LondonChemical Biology Centre, Department of Chemistry, Imperial College London2010

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