Potential red-flag identification of colorectal adenomas with wide-field fluorescence molecular endoscopy

Elmire Hartmans, Jolien J.J. Tjalma, Matthijs D. Linssen, Pilar Beatriz Garcia Allende, Marjory Koller, Annelies Jorritsma-Smit, Mariana e.Silva de Oliveira Nery, Sjoerd G. Elias, Arend Karrenbeld, Elisabeth G.E. de Vries, Jan H. Kleibeuker, Gooitzen M. van Dam, Dominic J. Robinson, Vasilis Ntziachristos, Wouter B. Nagengast*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Adenoma miss rates in colonoscopy are unacceptably high, especially for sessile serrated adenomas / polyps (SSA/Ps) and in high-risk populations, such as patients with Lynch syndrome. Detection rates may be improved by fluorescence molecular endoscopy (FME), which allows morphological visualization of lesions with high-definition white-light imaging as well as fluorescence-guided identification of lesions with a specific molecular marker. In a clinical proof-of-principal study, we investigated FME for colorectal adenoma detection, using a fluorescently labelled antibody (bevacizumab-800CW) against vascular endothelial growth factor A (VEGFA), which is highly upregulated in colorectal adenomas. Methods: Patients with familial adenomatous polyposis (n = 17), received an intravenous injection with 4.5, 10 or 25 mg of bevacizumab-800CW. Three days later, they received NIR-FME. Results: VEGFA-targeted NIR-FME detected colorectal adenomas at all doses. Best results were achieved in the highest (25 mg) cohort, which even detected small adenomas ( < 3 mm). Spectroscopy analyses of freshly excised specimen demonstrated the highest adenoma-to-normal ratio of 1.84 for the 25 mg cohort, with a calculated median tracer concentration in adenomas of 6.43 nmol/mL. Ex vivo signal analyses demonstrated NIR fluorescence within the dysplastic areas of the adenomas. Conclusion: These results suggest that NIR-FME is clinically feasible as a real-time, red-flag technique for detection of colorectal adenomas.

Original languageEnglish
Pages (from-to)1458-1467
Number of pages10
JournalTheranostics
Volume8
Issue number6
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • Near-infrared fluorescence
  • Optical molecular imaging
  • Spectroscopy
  • Vascular endothelial growth factor a

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