A new technology is providing physicians a way to diagnose hard-to-find cancers in the early stages, and offers patients hope for survival as a result of earlier detection. UAB gastroenterologists have one of only a few of the systems that are currently available worldwide.

 

 The Cellvizio^® confocal microscopy system uses one of the world’s smallest microscopes – less than 1/10 of an inch in diameter. The probe passes through the accessory channel of a standard endoscope or colonoscope. Both devices offer high magnifications, with resolutions in the range of 0.7 to 1.0 μm and optical penetration of the epithelium to a depth of 250 μm, a level of resolution that rivals light microscopy.

 

“When we drop this microscopic probe into the body, we are seeing cells at the microscopic level right then, so we can tell if something is wrong,” says Shyam Varadarajulu, MD, Associate Professor of Gastroenterology at UAB. “Without this tool, we might see something suspicious using endoscopy and do a biopsy. If the biopsy comes back negative, we think everything is okay while, in reality, it could be cancer that the biopsy missed.”

 

Gastroenterologists take biopsies frequently to send to a pathologist. While these biopsies are taken to analyze cells underneath the surface of tissue, gastroenterologists using modern endoscopes cannot see cells either on or underneath the surface. As a result, they must take many random, blind biopsies on a patient in hopes of getting a good sample of the possible cancer. In a tricky area of the body, the doctor may get only one biopsy that fails to provide an adequate tissue sample and leads to a “false negative” or missed cancer.

 

The ability to check out the cells in a patient’s digestive tract while still inside the patient’s body provides a fast and more accurate diagnosis of cancers in the bile duct, pancreas, esophagus, or colon. Those earlier diagnoses are saving lives.

 

“I’ve been using Cellvizio^® for about a month, and I’ve seen success already,” Varadarajulu says. “We treated a patient for what we thought was a stone in the bile duct. He came back recently with continuing problems, and we used the new microscope and saw cancer. The patient now is receiving chemotherapy treatment.”

 

Diagnosing billiary and pancreatic cancers has always been elusive. When gastroenterologists explore the bile duct using Endoscopic Retrograde Cholangiopancreatography (ERCP), they have a 40 to 50 percent chance of missing a cholangiocarcinoma. “Cellvizio’s real-time, cellular-level images let us see those abnormal, enlarged vessels that are indicative of a tumor,” Varadarajulu says.

 

Using the microscope to diagnose colon polyps will ultimately improve patient care and reduce lab costs and time associated with analyzing normal tissue. “Not all polyps are cancer,” Varadarajulu says. “Sometimes there are so many we don’t know what to biopsy. We can drop the Cellvizio^® microscope into each polyp and look at the cells so we know which ones to biopsy.”

 

Liver transplant patients also may benefit from this new technology, which can predict organ rejection. “We connect the donor liver to the patient’s bile duct,” Varadarajulu says. “If the patient is jaundiced, we can use the Cellvizio^® to check for rejection before the patient has symptoms. We’re still doing studies to see if this will be a viable use for this technology.”