Developments in molecular and advanced endoscopic imaging in esophageal cancer

Abstract

Esophageal cancer, including esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC), shows high incidence and poor prognosis. The early detection and endoscopic treatment of (pre)malignant lesions of esophageal cancer significantly improve disease outcomes of patients. However, the high-definition white-light endoscopy followed by random biopsy is reported with a non-ignorable miss rate. The development of advanced endoscopic techniques, such as fluorescence molecular endoscopy (FME) and endocytoscopy, can aid endoscopists in diagnosing early (pre)malignant lesions in vivo. FME realizes wide-field molecular imaging under endoscopy, which serves as a red flag technique for endoscopists by fluorescently highlighting the disease-specific molecule. In Chapter 3 and 4, we identified suitable target proteins and developed near-infrared fluorescent tracers for FME to detect ESCC and EAC at an early stage. In Chapter 6, we investigated the feasibility of assessing pathological response of EAC patients after neoadjuvant chemoradiotherapy by Bevacizumab-800CW guided FME.Endocytoscopy is a pin-point imaging technique that provides endoscopists with magnified optical cellular morphology and subcellular characteristics, referred to as an optical biopsy. In Chapter 5, we developed a classification criteria, an online training module for clinicians and a computer-aided diagnosis (CAD) algorithm based on in vivo images of fourth-generation endocytoscopy to distinguish dysplastic from non-dysplastic Barrett's esophagus tissue. We further investigated the interaction of this CAD algorithm with the clinicians