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In a recent clinical study of patients in the United States and China, Rice University bioengineers developed a low-cost, portable, battery-powered microendoscope that could eventually eliminate the need for expensive biopsies for many patients undergoing standard endoscopic screening for esophageal cancer.

The clinical study, involving 147 patients from the United States and China who were examined for potentially malignant squamous cell tumors, explored how a low-cost, high-resolution imaging system of rice could reduce the need for unnecessary biopsies when used in combination with traditional endoscopic light sources - the global standard of care for the diagnosis of esophageal cancer.

In this study, 147 suspected lesions were examined with conventional rice microendoscopy. Biopsies are obtained based on the results of traditional endoscopy.

Pathology showed that more than half of those biopsied - 58 percent - were free of high-grade cancer and precancerous lesions. The researchers found that an endoscopic exam could save 90 percent of patients from unnecessary biopsies for benign lesions. 'Biopsies are stressful and sometimes painful,' said lead investigator Rebecca Richards-Cotim, Rice's Stanley C. Moore Professor of Bioengineering and Director of Rice 360° Professor of Electrical and Computer Engineering: School of Global Health Technology. In addition, in low-resource Settings, pathology costs often exceed endoscopy costs. So microendoscopy can both improve patient outcomes and provide significant cost saving advantages if used in conjunction with traditional endoscopic light sources.'

On examination, cancerous and precancerous cells often appear different from healthy cells. The study of cell structure is called histology and usually requires a tumor histological analysis for an accurate diagnosis of the type and stage of the tumor. To determine if a biopsy histology exam is needed, health professionals often use an endoscopic light source, a small camera mounted on a flexible tube that can be inserted into the body to visually examine an organ or tissue without surgery. Rice's high-resolution microendoscope uses a 1-millimeter-wide cable that connects to a standard endoscope. The cable transmits images to a high-performance fluorescence microscope, and the endoscopist uses a tablet computer to view the microscope's output. The image resolution of the microendoscope provides similar histology to that of conventional endoscopists and allows individual cells and nuclei to be seen in suspected cancerous lesions.

By providing real-time histological data to endoscopists, rice's can help rule out cases that would otherwise require biopsy of malignant tumors. 'While tradition can rule over malignancies and eliminate the need for biopsy in some patients, in a large number of cases the differences between malignant and benign lesions only become apparent through histological analysis,' Study co-author Dr. Sharmila anandasabapathy, Baylor University medical director of the Baylor Global Initiative and professor of gastroenterology in the Baylor Center for Global Innovation.

Richards' lab worked on the development of Krugman's low-cost optical imaging and spectroscopy tools to detect cancer and infectious diseases at the point of care. Her research group is particularly interested in developing low-resource Settings for technology, and microendoscopy is part of this effort. It is battery powered, inexpensive and requires very little training. Clinical studies have shown that both experienced and novice endoscopists can use microendoscopy to perform biopsies requiring accurate evaluation of the results.

Clinical studies of rice are planned or underway for 12 types of cervical, bladder, oral, and colon cancers. 'More than half of cancer deaths today occur in developing countries, often in low-resource areas,' anandasabapathy said. The World Health Organization and other key international agencies have called for increased global attention to non-communicable diseases, such as cancer, and rice microendoscopy is a good example of what the right technology can do to transform health care in resource-poor countries.