Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Deep Inside the Body, Tiny Mechanical Microscope Diagnoses Disease

16.08.2012
Groundbreaking Technology, But Specialists Need Improved, Standardized Guidelines to Advance Diagnostic Accuracy, Says Weill Cornell Researcher

Tiny space age probes — those that can see inside single living cells — are increasingly being used to diagnose illness in hard-to-reach areas of the body.

NewYork-Presbyterian Hospital/Weill Cornell Medical Center’s Dr. Michel Kahaleh often threads a tiny microscope into the narrow bile ducts that connect the liver to the small intestine to hunt for cancer. He also uses the device to minutely explore the pancreatic duct as one of a few doctors in the country to use such technology in this way.

But because these devices are comparatively new, Dr. Kahaleh, chief of endoscopy at the Center for Advanced Digestive Care at NewYork-Presbyterian/Weill Cornell and professor of clinical medicine at Weill Cornell Medical College, suspected that the specialists who are beginning to use them may be interpreting what they see in different ways.

That’s exactly what he and his research team discovered, when they sent six different specialists at five different medical institutions recorded videos taken by a probe-based confocal laser endomicroscopy (pCLE) deep inside 25 patients with abnormally narrowed bile ducts.

The study, published in Digestive Diseases and Sciences, demonstrates there was “poor” to “fair” agreement on the clinical significance of what the physicians were viewing in the videos — whether what they saw represented cancer, simple inflammation, or a benign condition.

“That means physicians need to come up with a standard way of interpreting what the videos reveal in order to properly use this “amazing technology,” says senior author Dr. Kahaleh, who is also medical director of the Pancreas Program at Weill Cornell. “We can see detail that was just unimaginable a decade ago — this breakthrough is born for the bile duct and those tiny tubes and complicated organ structures that no one has ever been able to visualize before,” he says. “And when physicians are certain of what they are seeing, we will be able to greatly improve patient treatment, avoiding unnecessary surgery whenever possible.”

The Need to Know What You See

The human bile duct transports bile, secreted by the liver to aid in the process of digestion, to the small intestine. But inflammatory disease, the passing of gallstones or a tumor can cause the bile duct to constrict, resulting in a blockage that can lead to jaundice, cirrhosis, and other conditions.

The U.S. Food and Drug Administration approved pCLE diagnostic systems for use in the bile duct and pancreas two years ago. The pCLE is a mini microscopic probe that is threaded inside a larger “spy glass” probe. The pCLE can then image blood vessels, mucosal structures and epithelial tissue in real-time, broadcasting these images on a large monitor for physicians to examine.

But the vast majority of institutions may still use a rather hit-or-miss technique to determine if a bile duct is cancerous. The traditional technique is to thread a probe inside the duct to where it is abnormally narrowed and then to use a small brush or tiny forceps to gather some cells that can then be biopsied in a lab.“But we still miss 20-30 percent of bile duct cancer or other tumors in this way, and that is unacceptable,” Dr. Kahaleh says.

If a tumor is found in the bile duct, it can be removed, and a replacement can be fashioned out of the bowel. “It’s a big operation, and you want to make sure it is necessary,” says Dr. Kahaleh. “If there is any way to prevent surgery that would be a phenomenal advance for patient care.”

In this study, the six gastroenterologists trained in using bile duct pCLE were asked to analyze seven variables seen in the 30-second to 1-minute video clips, and diagnose whether the bile duct was cancerous or not. (Only the study coordinator knew the results in advance due to confirmation from tissue biopsies after surgery, or other evidence of malignancy.)

Diagnostic agreement between the specialists was poor to fair, depending on the variable, as was the final diagnosis.

“It is clear physicians need a standard by which to understand what they see, which will also need to involve more training,” says Dr. Kahaleh. “This is increasingly important, as these minimally invasive systems are proposed for use in diagnosing other health issues in the gastrointestinal tract, including ulcerative colitis and Barrett’s esophagus.”

“We can now see inside these tiny organs, but we just need to know exactly what we are looking at,” he adds.

The study’s co-authors include Dr. Jayant P. Talreja, Dr. Mihir R. Bakhru, and Dr. Bryan G. Sauer, from the University of Virginia; Dr. Amrita Sethi, from Columbia University Medical Center; Dr, Priya A. Jamidar and Dr. Uzma D. Siddiqui, from Yale University; Dr. Satish K. Singh from Boston University School of Medicine; Dr. Richard S. Kwon from the University of Michigan; Dr. Mandeep Sawhney from BIDMC in Boston; and Dr. Monica Gaidhane and Pam Kline from Weill Cornell Medical College.

NewYork-Presbyterian Hospital/Weill Cornell Medical Center

NewYork-Presbyterian Hospital/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and Weill Cornell Medical College, the medical school of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, education, research and community service. Weill Cornell physician-scientists have been responsible for many medical advances — including the development of the Pap test for cervical cancer; the synthesis of penicillin; the first successful embryo-biopsy pregnancy and birth in the U.S.; the first clinical trial for gene therapy for Parkinson’s disease; the first indication of bone marrow’s critical role in tumor growth; and, most recently, the world’s first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children’s Hospital, NewYork-Presbyterian Hospital/Westchester Division and NewYork-Presbyterian/The Allen Hospital. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. Weill Cornell Medical College is the first U.S. medical college to offer a medical degree overseas and maintains a strong global presence in Austria, Brazil, Haiti, Tanzania, Turkey and Qatar. For more information, visit www.nyp.org and weill.cornell.edu.

Takla Boujaoude | Newswise Science News
Further information:
http://ill.cornell.edu
http://www.nyp.org

More articles from Medical Engineering:

nachricht Wireless power can drive tiny electronic devices in the GI tract
28.04.2017 | Brigham and Women's Hospital

nachricht Artificial intelligence may help diagnose tuberculosis in remote areas
25.04.2017 | Radiological Society of North America

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Fighting drug resistant tuberculosis – InfectoGnostics meets MYCO-NET² partners in Peru

28.04.2017 | Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

 
Latest News

Wireless power can drive tiny electronic devices in the GI tract

28.04.2017 | Medical Engineering

Ice cave in Transylvania yields window into region's past

28.04.2017 | Earth Sciences

Nose2Brain – Better Therapy for Multiple Sclerosis

28.04.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>