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Endoscopic optical coherence tomography angiography microvascular features associated with dysplasia in Barrett's esophagus (with video).

ABSTRACT: Angiogenesis is associated with neoplastic progression of Barrett's esophagus (BE). Volumetric optical coherence tomography angiography (OCTA) visualizes subsurface microvasculature without exogenous contrast agents. We investigated the association of OCTA microvascular features with low-grade dysplasia (LGD) and high-grade dysplasia (HGD).Fifty-two patients undergoing BE surveillance or endoscopic eradication therapies for dysplasia were imaged using volumetric OCTA and corresponding histologic diagnoses wre obtained to yield 97 data sets (nondysplastic BE [NDBE], 74; LGD, 10; HGD, 13). After evaluating OCTA image quality, 54 datasets (NDBE, 35; LGD, 8; HGD, 11) from 32 patients were used to develop a training and reading protocol. The association of abnormal vessel branching and heterogeneous vessel size with LGD/HGD and a regular honeycomb vessel pattern with NDBE were investigated.Blinded OCTA reading of 41 OCTA datasets (NDBE, 27; LGD, 7; HGD, 7) was performed by readers with various levels of OCT/OCTA experience including 3 OCT trainees, 1 gastroenterologist, and 2 gastroenterology fellows. Among the 6 readers, OCTA features of abnormal vessel branching and heterogeneous vessel size had an overall 94% sensitivity (95% CI, 89-99) and 69% specificity (95% CI, 62-76) for differentiating LGD/HGD versus NDBE with a mean reading time of 45 seconds per data set and moderate (kappa = .58) interobserver agreement.Volumetric en face OCTA imaging enables rapid examination of depth resolved microvascular features with near-microscopic resolution. OCTA can visualize microvascular features associated with LGD/HGD with high accuracy, which motivates new technologic advances and future studies investigating the diagnostic performance of OCTA.

SUBMITTER: Lee HC

PROVIDER: S-EPMC5545067 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Endoscopic optical coherence tomography angiography microvascular features associated with dysplasia in Barrett's esophagus (with video).

Lee Hsiang-Chieh HC Ahsen Osman O OO Liang Kaicheng K Wang Zhao Z Figueiredo Marisa M Giacomelli Michael G MG Potsaid Benjamin B Huang Qin Q Mashimo Hiroshi H Fujimoto James G JG

Gastrointestinal endoscopy 20170205 3

<h4>Background and aims</h4>Angiogenesis is associated with neoplastic progression of Barrett's esophagus (BE). Volumetric optical coherence tomography angiography (OCTA) visualizes subsurface microvasculature without exogenous contrast agents. We investigated the association of OCTA microvascular features with low-grade dysplasia (LGD) and high-grade dysplasia (HGD).<h4>Methods</h4>Fifty-two patients undergoing BE surveillance or endoscopic eradication therapies for dysplasia were imaged using ...[more]

PMID: 28167119

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Project description:BackgroundRadiofrequency ablation (RFA) is effective for treating Barrett's esophagus (BE) but often involves multiple endoscopy sessions over several months to achieve complete response.ObjectiveIdentify structural markers that correlate with treatment response by using 3-dimensional (3-D) optical coherence tomography (OCT; 3-D OCT).DesignCross-sectional.SettingSingle teaching hospital.PatientsThirty-three patients, 32 male and 1 female, with short-segment (<3 cm) BE undergoing RFA treatment.InterventionPatients were treated with focal RFA, and 3-D OCT was performed at the gastroesophageal junction before and immediately after the RFA treatment. Patients were re-examined with standard endoscopy 6 to 8 weeks later and had biopsies to rule out BE if not visibly evident.Main outcome measurementsThe thickness of BE epithelium before RFA and the presence of residual gland-like structures immediately after RFA were determined by using 3-D OCT. The presence of BE at follow-up was assessed endoscopically.ResultsBE mucosa was significantly thinner in patients who achieved complete eradication of intestinal metaplasia than in patients who did not achieve complete eradication of intestinal metaplasia at follow-up (257 ± 60 μm vs 403 ± 86 μm; P < .0001). A threshold thickness of 333 μm derived from receiver operating characteristic curves corresponded to a 92.3% sensitivity, 85% specificity, and 87.9% accuracy in predicting the presence of BE at follow-up. The presence of OCT-visible glands immediately after RFA also correlated with the presence of residual BE at follow-up (83.3% sensitivity, 95% specificity, 90.6% accuracy).LimitationsSingle center, cross-sectional study in which only patients with short-segment BE were examined.ConclusionThree-dimensional OCT assessment of BE thickness and residual glands during RFA sessions correlated with treatment response. Three-dimensional OCT may predict responses to RFA or aid in making real-time RFA retreatment decisions in the future.

Dataset Information

Endoscopic optical coherence tomography angiography microvascular features associated with dysplasia in Barrett's esophagus (with video).

Publications

Endoscopic optical coherence tomography angiography microvascular features associated with dysplasia in Barrett's esophagus (with video).

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