Just as cameras and televisions have been reinvented in the last decade with improved optics, sharpness and brightness, so have the tiny imaging scopes that physicians use to peer into the body’s nooks and crannies — its organs and digestive system. Researchers at the Florida campus of Mayo Clinic are testing the power of these new endoscopic optics to potentially help prevent or detect early colon cancer, lung cancer metastasis, and esophageal cancer. Results of a number of these studies, led by Michael Wallace, M.D., M.P.H., professor of medicine, are being presenting at the annual international scientific conference, Digestive Disease Week (DDW) 2010.
In one study, for example, gastroenterologists at Mayo have pitted multiple high-tech probes against each other to see how well they detect the tiniest precancerous polyp in the colon. They have determined that one endoscopic imaging tool called the probe-based confocal laser endomicroscopy (pCLE) shows the highest accuracy yet in detecting small precancerous polyps inside the colon wall. The probe is only one-sixteenth of an inch in diameter.
“We can see detail that was unimagined 10 years ago,” says Dr. Wallace. “We can zoom in on a potential problem spot in the colon with 1,000-fold magnification, leading to a day when we can perform virtual biopsies on patients – meaning that we will be able to tell if a lesion is precancerous by looking at it, and if it isn’t, we can leave it alone. Now we have to remove anything that looks even slightly suspicious.”
In another study, Dr. Wallace has shown that pCLE can reduce the number of biopsies necessary in Barrett’s esophagus, a condition where the tissue lining the esophagus is replaced by tissue that is similar to the lining of the intestine —which can then morph into cancer. Using pCLE can therefore reduce laborious and painful screening in patients with Barrett’s esophagus, he says.
Researchers at Mayo Clinic are also testing other scopes to search lymph nodes outside of the lung for evidence of micrometastatis — the spread of cancer cells that can’t easily be seen. They have found that threading a scope down the esophagus to remove a biopsy of lymph nodes near the lungs, and then testing the tissue with a panel of five molecules, can indicate cancer spread in lymph nodes that were thought to be cancer free when examined in other ways.
The findings suggest that this technology, dubbed EUS-FNA (endoscopic ultrasound–fine needle aspiration), can help physicians decide which therapy to offer patients whose lymph nodes show cancer spread.
Below is a link to an edited youtube video with Dr. Wallace.