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Clinical: New Diagnostic Technologies Monday, May 20, 2002

2002; Elsevier BV; Volume: 55; Issue: 5 Linguagem: Inglês

10.1016/s0016-5107(02)70279-4

1097-6779

Dave Mccann, Susie Lee, Govind Bhagat, Alice Yoo, Charles J. Lightdale, Peter D. Stevens, Shai Friedland, Roy Soetikno, Wolfgang Avenhaus, Björn Kemper, Sabine Knoche, Christian Poremba, Gert von Bally, Richard J. Farrell, Banke Agarwal, Steven L. Brandwein, John R. Underhill, Ram Chuttani, Douglas K. Pleskow, Bhaskar Banerjee, Holakere Chandrasekhar,

Background: Optical coherence tomography (OCT) is a new high-resolution imaging technique that functions by directing infrared light into tissue and measuring the reflected interference patterns.OCT resolution is from 5 to10 microns, which makes it capable of detecting histological changes without the need for biopsy.We compared OCT images obtained from the pancreatic ducts of resected Whipple specimens with histologic sections in order to determine the utility of OCT in diagnosing inflammatory and neoplastic pancreatic pathologies.Methods: A total of 60 radial OCT images were acquired at 1 millimeter intervals from surgically resected pancreatic specimens.These specimens were resected from patients with diagnoses of adenocarcinoma and chronic pancreatitis.The OCT catheter was passed into the pancreatic duct and placed in contact with the pancreatic duct epithelium.A total of 60 histologic sections were taken from the corresponding locations for comparison with the OCT images.Results: We found that the OCT images corresponded to several specific findings on histologic sectioning.Normal pancreatic ductal epithelium was identified in 15 histologic sections and appeared as a single layer of discrete hyperdense foci on OCT.Submucosal glands appeared as hypodense areas deep to the epithelium, with glandular morphology corresponding to that found on histology.Strictures were visualized by OCT as a thick homogeneous hyperdense layer along with decrease luminal diameter and corresponded to periductal fibrosis as visualized in 7 histologic sections.Periductal inflammation was identified in 22 sections and appeared as a disorganized hypodense background on OCT.Finally, dysplastic epithelial nuclei were identified in 12 sections and appeared as stratified layers of discrete hyperdense foci on OCT.In the remaining sections the histology was not identifiable due to preparation artifact.Conclusions: OCT is a promising technique for detecting superficial histologic changes in organs accessible by an OCT catheter.Using OCT we have characterized various pancreatic processes including inflammation, fibrosis, and dysplasia of the pancreatic duct.This technique may prove useful to rule out dysplasia or inflammation in difficult-to-diagnose pancreatic strictures.The predictive value of OCT findings can be tested in the future through prospective blinded studies correlating OCT images with histological findings.