Design and evaluation of an antenna applicator for a microwave colonoscopy system

© 2019 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes,creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.This paper presents a design of a compact antenna applicator for a microwave colonoscopy system. Although colonoscopy is the most effective method for colorectal cancer detection, it suffers from important visualization restrictions that limit its performance. We recently reported that the contrast between healthy mucosa and cancer was 30%-100% for the relative permittivity and conductivity, respectively, at 8 GHz, and the complex permittivity increased proportionally to the degeneration rate of polyps (cancer precursors). The applicator is designed as a compact cylindrical array of eight antennas attached at the tip of a conventional colonoscope. The design presented here is a proof-of-concept applicator composed by one transmitting and one receiving cavity-backed U-shaped slot antenna elements fed by an L-shaped microstrip line. The antennas are low profile and present a high isolation at 8 GHz. The antenna performance is assessed with simulations and experimentally with a phantom composed by different liquids.Peer ReviewedPostprint (author's final draft

Automatic polyp detection using microwave endoscopy for colorectal cancer prevention and early detection: phantom validation

A system to integrate microwave imaging with optical colonoscopy is presented. The overarching goal is to improve the prevention and early diagnosis of one of the main health and economic burdens of an increasingly aging population, i.e., colorectal cancer. For a colonoscopy, the gold standard for colorectal cancer diagnosis, 22% of polyps are not detected, and the risk of cancer after a negative colonoscopy can be up to 7.9%. To remedy this, a microwave imaging system able to generate an alarm when a polyp is detected is designed, manufactured and validated with a colon phantom composed of tissue-mimicking oil-gelatin materials reproducing the anatomy and dielectric properties of a human colon with a polyp. The acquisition was performed by a miniaturized ring-shaped switched array of 16 antennas attachable at the tip of a conventional colonoscope. This has been conceived to satisfy endoscopy size restrictions, patient safety and intercompatibility with current clinical practice. A Modified Monofocusing imaging method preceded by a previous frame average subtraction as a calibration technique shows a perfect detection of a 10-mm polyp (100% sensitivity and specificity) in the eight analyzed trajectories. The phantom results demonstrate the feasibility of the system in future preclinical trials.The work of Alejandra Garrido was supported by DIN2019-010857. The work of Roberto Sont, Ignasi Belda, and Marta Guardiola was supported in part by the European Union’s Horizon 2020 Research and Innovation Programme under Grant 960251 and in part by the European Institute of Innovation and Technology (EIT). The work of Jordi Romeu was supported by PID2019-107885GB-C31/AEI/10.13039/501100011033.Peer ReviewedPostprint (published version

Dielectric properties of colon polyps, cancer, and normal mucosa: Ex vivo measurements from 0.5 to 20 GHz

This is the accepted version of the following article: Guardiola, M. , Buitrago, S. , Fernández‐Esparrach, G. , O'Callaghan, J. M., Romeu, J. , Cuatrecasas, M. , Córdova, H. , González Ballester, M. Á. and Camara, O. (2018), Dielectric properties of colon polyps, cancer, and normal mucosa: Ex vivo measurements from 0.5 to 20 GHz. Med. Phys., 45: 3768-3782. doi:10.1002/mp.13016, which has been published in final form at https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.13016. This article may be used for non-commercial purposes in accordance with the Wiley Self-Archiving Policy [http://olabout.wiley.com/WileyCDA/Section/id-820227.html].Colorectal cancer is highly preventable by detecting and removing polyps, which are the precursors. 20 Currently, the most accurate test is colonoscopy, but still misses 22% of polyps due to visualization limitations. In this paper we preliminary assess the potential of microwave imaging and dielectric properties (e.g. complex permittivity) as a complementary method for detecting polyps and cancer tissue in the colon. The dielectric properties of biological tissues have been used in a wide variety of applications, including safety assessment of wireless technologies and design of medical diagnostic or therapeutic techniques 25 (microwave imaging, hyperthermia and ablation). The main purpose of this work is to measure the complex permittivity of different types of colon polyps, cancer and normal mucosa in ex vivo human samples to study if the dielectric properties are appropriate for classification purposes.Peer ReviewedPostprint (author's final draft

Microwave-Based Colonoscopy: Preclinical Evaluation in an Ex Vivo Human Colon Model

Introduction: Microwave imaging can obtain 360° anatomical and functional images of the colon representing the existing contrast in dielectric properties between different tissues. Microwaves are safe (nonionizing) and have the potential of reducing the visualization problems of conventional colonoscopy. This study assessed the efficacy of a microwave-based colonoscopy device to detect neoplastic lesions in an ex vivo human colon model. Methods: Fresh surgically excised colorectal specimens containing cancer or polyps were fixed to a 3D positioning system, and the accessory device was introduced horizontally inside the ex vivo colon lumen and moved along it simulating a real colonoscopy exploration. Measurements of the colon were taken every 4 mm with the microwave-based colonoscopy device and processed with a microwave imaging algorithm. Results: 14 ex vivo human colorectal specimens with carcinomas (n = 11) or adenomas with high grade dysplasia (n = 3) were examined with a microwave-based device. Using a detection threshold of 2.79 for the dielectric property contrast, all lesions were detected without false positives or false negatives. Conclusions: This study demonstrates the use of a microwave-based device to be used as an accessory of a standard colonoscope to detect neoplastic lesions in surgically excised colorectal specimens

Successful outcomes of a new combined solution of hyaluronic acid, chondroitin sulfate and poloxamer 407 for submucosal injection: animal survival study

Background: and study aims Endoscopic resection requires use of submucosal injection. This study was conducted to assess efficacy and impact on early healing of hyaluronic acid combined with chondroitin sulfate and poloxamer 407 (Ziverel) when used as a solution for submucosal injection. Materials: and methods Prospective and comparative study of gastric endoscopic mucosal resection (EMR) with three groups of two Yorkshire pigs. Six submucosal cushions were created in each animal by injecting 2 mL of Ziverel (Group 1) or succinylated gelatin (SG) (Group 2), enabling 12 EMR in each group. Submucosal cushions were created with Ziverel in Group 3, without resection. Electrosurgery unit settings were the same in all cases. EMR defects and injection sites were marked with clips. The animals were sacrificed 7 days later. EMR specimen size and duration of procedure were recorded. EMR specimens and EMR scars and injection sites were evaluated by a blinded pathologist. Results: We successfully performed 24 EMR (15 en-bloc and 9 piecemeal, without differences between groups 1 and 2). Mean EMR specimen dimensions were significantly larger in Group 1 (median 19 mm, range 6 - 40 vs 16.6 mm, range 5‑25; P = 0.019), without changing the electrocautery unit settings. Blinded histopathologist assessment of EMR specimens showed less fibrosis in the submucosa and a trend to fewer cautery artifacts with Ziverel and did not identify any significant differences in early healing of resection sites. Conclusion: The combination of Ziverel enables EMR and does not negatively affect early healing

In vivo computer-aided diagnosis of colorectal polyps using white light endoscopy

Background and study aims Artificial intelligence is currently able to accurately predict the histology of colorectal polyps. However, systems developed to date use complex optical technologies and have not been tested in vivo. The objective of this study was to evaluate the efficacy of a new deep learning-based optical diagnosis system, ATENEA, in a real clinical setting using only high-definition white light endoscopy (WLE) and to compare its performance with endoscopists. Methods ATENEA was prospectively tested in real life on consecutive polyps detected in colorectal cancer screening colonoscopies at Hospital Clínic. No images were discarded, and only WLE was used. The in vivo ATENEA's prediction (adenoma vs non-adenoma) was compared with the prediction of four staff endoscopists without specific training in optical diagnosis for the study purposes. Endoscopists were blind to the ATENEA output. Histology was the gold standard. Results Ninety polyps (median size: 5 mm, range: 2-25) from 31 patients were included of which 69 (76.7 %) were adenomas. ATENEA correctly predicted the histology in 63 of 69 (91.3 %, 95 % CI: 82 %-97 %) adenomas and 12 of 21 (57.1 %, 95 % CI: 34 %-78 %) non-adenomas while endoscopists made correct predictions in 52 of 69 (75.4 %, 95 % CI: 60 %-85 %) and 20 of 21 (95.2 %, 95 % CI: 76 %-100 %), respectively. The global accuracy was 83.3 % (95 % CI: 74%-90 %) and 80 % (95 % CI: 70 %-88 %) for ATENEA and endoscopists, respectively. Conclusion ATENEA can accurately be used for in vivo characterization of colorectal polyps, enabling the endoscopist to make direct decisions. ATENEA showed a global accuracy similar to that of endoscopists despite an unsatisfactory performance for non-adenomatous lesions

Dielectric properties of colon polyps, cancer and normal mucosa: ex vivo measurements from 0.5 to 20 GHz

Purpose: Colorectal cancer is highly preventable by detecting and removing polyps, which are the precursors. Currently, the most accurate test is colonoscopy, but still misses 22% of polyps due to visualization limitations. In this paper, we preliminary assess the potential of microwave imaging and dielectric properties (e.g., complex permittivity) as a complementary method for detecting polyps and cancer tissue in the colon. The dielectric properties of biological tissues have been used in a wide variety of applications, including safety assessment of wireless technologies and design of medical diagnostic or therapeutic techniques (microwave imaging, hyperthermia, and ablation). The main purpose of this work is to measure the complex permittivity of different types of colon polyps, cancer, and normal mucosa in ex vivo human samples to study if the dielectric properties are appropriate for classification purposes. Methods: The complex permittivity of freshly excised healthy colon tissue, cancer, and histological samples of different types of polyps from 23 patients was characterized using an open-ended coaxial probe between 0.5 and 20 GHz. The obtained measurements were classified into five tissue groups before applying a data reduction step with a frequency dispersive single-pole Debye model. The classification was finally compared with pathological analysis of tissue samples, which is the gold standard. Results: The complex permittivity progressively increases as the tissue degenerates from normal to cancer. When comparing to the gold-standard histological tissue analysis, the sensitivity and specificity of the proposed method is the following: 100% and 95% for cancer diagnosis; 91% and 62% for adenomas with high-grade dysplasia; 100% and 61% for adenomas with low-grade dysplasia; and 100% and 74% for hyperplastic polyps, respectively. In addition, complex permittivity measurements were independent of the lesion shape and size, which is also an interesting property comparing to current colonoscopy techniques. Conclusions: The contrast in complex permittivities between normal and abnormal colon tissues presented here for the first time demonstrate the potential of these measurements for tissue classification. It also opens the door to the development of a microwave endoscopic device to complement the outcomes of colonoscopy with functional tissue informatio

Experimental study of hybrid-knife endoscopic submucosal dissection (ESD) versus standard ESD in a Western country

BACKGROUND: Endoscopic submucosal dissection (ESD) is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise. OBJECTIVE: The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with high pressure water jet and to compare with standard ESD. MATERIAL AND METHODS: We performed a prospective non survival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard). RESULTS: Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0 (hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04). Hybrid-knife ESD was faster than standard (time: 44.6 +/- 21.4 minutes vs. 68.7 +/- 33.5 minutes; p = 0.009 and velocity: 20.8 +/- 9.2 mm(2)/min vs. 14.3 +/- 9.3 mm(2)/min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 +/- 15.68 to 28.18 +/- 20.07 mm(2)/min; p = 0.615 and standard: From 6.4 +/- 0.3 to 19.48 +/- 19.21 mm(2)/min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %). CONCLUSION: despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybrid knife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results

Accuracy of colon capsule endoscopy in detecting colorectal polyps in individuals with familial colorectal cancer: could we avoid colonoscopies?

Background. Individuals with a family history of colorectal cancer (CRC) have an increased risk of CRC. We evaluated the diagnostic yield of CCE in the detection of lesions and also two different colon preparations. Methods. A prospective multicenter study was designed to assess CCE diagnostic yield in a cohort of asymptomatic individuals with a family history of CRC. CCE and colonoscopy were performed on the same day by 2 endoscopists who were blinded to the results of the other procedure. Results. Fifty-three participants were enrolled. The sensitivity, specificity, PPV, and NPV of CCE for detecting advanced adenomas were 100%, 98%, 67%, and 100%. Sensitivity, specificity, PPV, and NPV of CCE for the diagnosis of individuals with polyps were 87%, 97%, 93%, and 88%, respectively. CCE identify 100% of individuals with significant or advanced lesions. Overall cleanliness was adequate by 60.7% of them. The PEG-ascorbic boost seems to improve colon cleanliness, with similar colonic transit time. Conclusion. CCE is a promising tool, but it has to be considered as an alternative technique in this population in order to reduce the number of colonoscopies performed. More studies are needed to understand appropriate screening follow-up intervals and optimize the bowel preparation regimen

Adjuvant therapy sparing in rectal cancer achieving complete response after chemoradiation

AIM: To evaluate the long-term results of conventional chemoradiotherapy and laparoscopic mesorectal excision in rectal adenocarcinoma patients without adjuvant therapy. METHODS: Patients with biopsy-proven adenocarcinoma of the rectum staged cT3-T4 by endoscopic ultrasound or magnetic resonance imaging received neoadjuvant continuous infusion of 5-fluorouracil for five weeks and concomitant radiotherapy. Laparoscopic surgery was planned after 5-8 wk. Patients diagnosed with ypT0N0 stage cancer were not treated with adjuvant therapy according to the protocol. Patients with ypT1-2N0 or ypT3-4 or N+ were offered 5-fluorouracil-based adjuvant treatment on an individual basis. An external cohort was used as a reference for the findings. RESULTS: One hundred and seventy six patients were treated with induction chemoradiotherapy and 170 underwent total mesorectal excision. Cancer staging of ypT0N0 was achieved in 26/170 (15.3%) patients. After a median follow-up of 58.3 mo, patients with ypT0N0 had five-year disease-free and overall survival rates of 96% (95%CI: 77-99) and 100%, respectively. We provide evidence about the natural history of patients with localized rectal cancer achieving a complete response after preoperative chemoradiation. The inherent good prognosis of these patients will have implications for clinical trial design and care of patients. CONCLUSION: Withholding adjuvant chemotherapy after complete response following standard neoadjuvant chemoradiotherapy and laparoscopic mesorectal excision might be safe within an experienced multidisciplinary team