PT  - JOURNAL ARTICLE
AU  - Gabriëls, Ruben Y.
AU  - van Heijst, Lisanne E.
AU  - Hooghiemstra, Wouter T.R.
AU  - van der Waaij, Anne M.
AU  - Kats-Ugurlu, Gursah
AU  - Karrenbeld, Arend
AU  - Robinson, Dominic J.
AU  - Tenditnaya, Anna
AU  - Ntziachristos, Vasilis
AU  - Gorpas, Dimitris
AU  - Nagengast, Wouter B.
TI  - Detection of Early Esophageal Neoplastic Barrett Lesions with Quantified Fluorescence Molecular Endoscopy Using Cetuximab-800CW
AID  - 10.2967/jnumed.122.264656
DP  - 2023 May 01
TA  - Journal of Nuclear Medicine
PG  - 803--808
VI  - 64
IP  - 5
4099  - http://jnm.snmjournals.org/content/64/5/803.short
4100  - http://jnm.snmjournals.org/content/64/5/803.full
SO  - J Nucl Med2023 May 01; 64
AB  - Esophageal adenocarcinoma causes 6% of cancer-related deaths worldwide. Near-infrared fluorescence molecular endoscopy (NIR-FME) uses a tracer that targets overexpressed proteins. In this study, we aimed to investigate the feasibility of an epidermal growth factor receptor (EGFR)–targeted tracer, cetuximab-800CW, to improve detection of early-stage esophageal adenocarcinoma. Methods: We validated EGFR expression in 73 esophageal tissue sections. Subsequently, we topically administered cetuximab-800CW and performed high-definition white-light endoscopy (HD-WLE), narrow-band imaging, and NIR-FME in 15 patients with Barrett esophagus (BE). Intrinsic fluorescence values were quantified using multidiameter single-fiber reflectance and single-fiber fluorescence spectroscopy. Back-table imaging, histopathologic examination, and EGFR immunohistochemistry on biopsy samples collected during NIR-FME procedures were performed and compared with in vivo imaging results. Results: Immunohistochemical preanalysis showed high EGFR expression in 67% of dysplastic tissue sections. NIR-FME visualized all 12 HD-WLE–visible lesions and 5 HD-WLE–invisible dysplastic lesions, with increased fluorescence signal in visible dysplastic BE lesions compared with nondysplastic BE as shown by multidiameter single-fiber reflectance/single-fiber fluorescence, reflecting a target-to-background ratio of 1.5. Invisible dysplastic lesions also showed increased fluorescence, with a target-to-background ratio of 1.67. Immunohistochemistry analysis showed EGFR overexpression in 16 of 17 (94%) dysplastic BE lesions, which all showed fluorescence signal. Conclusion: This study has shown that NIR-FME using cetuximab-800CW can improve detection of dysplastic lesions missed by HD-WLE and narrow-band imaging.