A tablet-interfaced high-resolution microendoscope with automated image interpretation for real-time evaluation of esophageal squamous cell neoplasia

Abstract

Background and Aims In recent years, high-resolution microendoscopy (HRME) has shown potential to improve screening for esophageal squamous cell neoplasia (ESCN). Furthering its utility in a clinical setting, especially in lower-resource settings, could be accomplished by reducing the size and cost of the system as well as incorporating the ability of real-time, objective feedback. This article describes a tablet-interfaced HRME with fully automated, real-time image analysis. Methods The performance of the tablet-interfaced HRME was assessed by acquiring images from the oral mucosa in a normal volunteer. An automated, real-time analysis algorithm was developed and evaluated using training, test, and validation images from a previous in vivo study of 177 patients referred for screening or surveillance endoscopy in China. The algorithm was then implemented in a tablet HRME that was used to obtain and analyze images from esophageal tissue in 3 patients. Images were displayed alongside the probability that the imaged region was neoplastic. Results The tablet-interfaced HRME demonstrated comparable imaging performance at lower cost compared with first-generation laptop-interfaced HRME systems. In a post-hoc quantitative analysis, the algorithm identified neoplasia with a sensitivity and specificity of 95% and 91% in the validation set, compared with 84% and 95% achieved in the original study. Conclusion The tablet-based HRME is a low-cost tool that provides quantitative diagnostic information to the endoscopist in real-time. This could especially be beneficial in lower-resource settings for operators with less experience interpreting HRME images.

Differential structured illumination microendoscopy for in vivo imaging of molecular contrast agents

“…Normal squamous epithelium is characterized by regularly spaced, small nuclei. In contrast, the area of HSIL showed larger, more closely spaced nuclei, which is consistent with previous studies using high resolution microendoscopy to study squamous epithelium where increased nuclear density and nuclear size are observed and can be quantified in dysplastic tissue (13,14,31). The DSIMe images corresponding to the HSIL region showed improved image contrast.…”

Prospective Evaluation of Multimodal Optical Imaging with Automated Image Analysis to Detect Oral Neoplasia In Vivo

“…Instrumentation upgrades would entail reducing the size and cost of the systems and reducing the image acquisition times to improve image quality. Additionally, integration into the clinical workflow could be aided by use of tablet-based interfaces, which has been reported in tandem with the HRME (30). Future work will also entail implementing the automated image analysis in real-time in order to investigate how the availability of real-time diagnostic information will impact the clinician’s decision making process.…”

“…HRME images for each site were analyzed using an automated image analysis procedure (30). Briefly, the algorithm first identifies regions in the HRME image that are free of areas that are too bright or too dim, adjusts the contrast of the image, and converts the image into a binary image to separate the nuclei from the cytoplasm.…”

“…Additional metrics included ratio of nuclear intensity to cytoplasmic intensity, Weber contrast, Michelson contrast, and nuclear to cytoplasmic area ratio. Additionally, each nucleus in the FOV was classified as normal or abnormal using criteria based on nuclear area and eccentricity reported in Quang el al (30). In this case, a nucleus was defined as abnormal if its nuclear area was greater than or equal to 162.9 μm 2 and nuclear eccentricity was greater than or equal to 0.686.…”

Artificial intelligence and upper gastrointestinal endoscopy: Current status and future perspective

“…Esophageal cancer is the sixth leading cause of cancer death worldwide. Most deaths occur in developing countries because of late‐stage diagnosis, and where nearly all cases are esophageal SCC . Lugol's chromoendoscopy is currently considered the gold‐standard screening method to identify SCC during gastroscopy; however, its specificity is low (approximately 70%) whereas its sensitivity is considered >90%.…”