Tissue parameters reconstructed from in vivo spectroscopic measurements in the bile duct.
bile duct cancers, hyperchromasia, cancer, inflammation, dysplasia, pancreatic ductal adenocarcinoma of the bile duct, high-grade dysplasia, biliary duct pre-cancer, cholangiocarcinoma
BILE DUCT CANCERS, ENLARGEMENT, CANCER, INFLAMMATION, DYSPLASIA, CHOLANGIOCARCINOMA
The bar color represents clinical diagnosis. The red bars represent high-grade dysplasia or cancer, blue – low-grade dysplasia, green—benign with inflammation and bright green—benign. Bar heights represent tissue parameters reconstructed from in vivo spectroscopic measurements with the highest LSS-based diagnostic parameter ∆ (Epithelial cells found in the bile duct might have various shapes. Intrahepatic biliary epithelium is lined by cuboidal cells, extrahepatic biliary epithelium is lined by columnar cells, and hilar epithelium is lined by both cuboidal and columnar cells. However, despite the shape differences, high-grade dysplasia develops in all these epithelial cells with similar important histopathological characteristics: nuclear enlargement, hyperchromasia, and cell crowdingOut of 29 consecutively enrolled patients, 17 were without any suspicion for cholangiocarcinoma. For this subgroup, the diagnostic accuracy is 100% (95% CI: 82-100%), very similar to the diagnostic accuracy of the entire pool of 29 subjects. Interestingly, among this subgroup of patients without any suspicion for cholangiocarcinoma, 3 subjects were later diagnosed by histopathology or cytology to have cholangiocarcinoma and 1 to have pancreatic ductal adenocarcinoma of the bile duct. All 4 patients were correctly categorized by our technology prior to the diagnosis.At the same time, classification capabilities of the hemoglobin concentration, hemoglobin oxygen saturation and subepithelial scattering power, which can be reconstructed from the DRS data (Fig. Though the increase in the hemoglobin concentration could be explained by angiogenesis and the decrease in oxygen saturation from ~72% on average for benign and inflammation sites to below 65% on average for high-grade dysplasia and cancer sites is consistent with the changes that has previously been observed in various gastrointestinal organs such as esophagusTo test the classification capabilities of DRS-based parameters, we employed the receiver operating characteristic (ROC) approach to evaluate their potential sensitivities and specificities (see Fig. Currently, surgery for resectable bile duct cancers require not only removal of the bile duct, but also removal of part of the liver, nearby lymph nodes, and the gallbladder. In many cases, this is not enough and the Whipple procedure is performed. During the Whipple procedure, which has high morbidity and mortality ratesThe review of the LSS data shows that in one of the subjects (subject 17, Fig. In conclusion, we present here a minimally invasive optical spectroscopic technique showing that it is possible to reliably identify biliary duct pre-cancer and early cancer in vivo non-invasively. A major advantage of the technique is that the developed relatively inexpensive spatial gating fiber optic probe could be easily miniaturized to fit the most restricted spaces of cholangioscopes and ERCP catheters. About half a million ERCP procedures with conventional ERCP catheters are performed annually in the United States