Quantitative attenuation analysis for identification of early Barrett's neoplasia in volumetric laser endomicroscopy

Early neoplasia in Barrett's esophagus (BE) is difficult to detect. Volumetric laser endomicroscopy (VLE) incorporates optical coherence tomography, providing a circumferential scan of the esophageal wall layers. The attenuation coefficient (μ_VLE) quantifies decay of detected backscattered light versus depth, and could potentially improve BE neoplasia detection. The aim is to investigate feasibility of μ_VLE for identification of early BE neoplasia. In vivo and ex vivo _VLE scans with histological correlation from BE patients neoplasia were used. Quantification by μ_VLE was performed manually on areas of interest (AoIs) to differentiate neoplasia from nondysplastic (ND)BE. From ex vivo _VLE scans from 16 patients (13 with neoplasia), 68 AoIs were analyzed. Median μ_VLE values (mm^-1) were 3.7 [2.1 to 4.4 interquartile range (IQR)] for NDBE and 4.0 (2.5 to 4.9 IQR) for neoplasia, not statistically different (p = 0.82). Fourteen in vivo scans were used: nine from neoplastic and five from NDBE patients. Median μ_VLE values were 1.8 (1.5 to 2.6 IQR) for NDBE and 2.1 (1.9 to 2.6 IQR) for neoplasia, with no statistically significant difference (p = 0.37). In conclusion, there was no significant difference in μ_VLE values in _VLE scans from early neoplasia versus NDBE. Future studies with a larger sample size should explore other quantitative methods for detection of neoplasia during BE surveillance.