Publication
The aim of this thesis is to optimise and gain fundamental information on two applications of photomedicine using fluorescence imaging and spectrofluorometry: (1) the detection of early bronchial cancer by autofluorescence imaging and (2) the endometrial ablation by photodynamic therapy (PDT) based on the use of Protoporphyrin IX (PpIX). Fluorescence imaging and spectroscopy require a fluorochrome localised within the tissue. The fluorochrome can either be endogenous (naturally synthesised in the body), endogenously induced (synthesised in the body from an administered drug), or exogenous (synthesised outside the body). This thesis concentrates on the clinical applications of the endogenous and an endogenously induced fluorochrome (PpIX). Therefore, this work has been divided into two parts according to the type of fluorochromes. The numerous endogenous fluorochromes occur naturally. They are collectively responsible for the fluorescence properties of biological tissues. This tissue's intrinsic fluorescence is also referred to as autofluorescence (AF). The AF of bronchial tissues, change when they become dysplastic or neoplastic. Early neoplastic or dysplastic lesions show an overall decrease in the AF intensity as well as a distorsion of the spectral shape. Endoscopic imaging devices rely on this principle to detect early neoplastic lesions in the tracheo-bronchial tree. The first part of this thesis describes our efforts to improve the performance of AFB and to gather insight into the mechanisms at the origin of the AF contrast in the bronchi. For this purpose, we conducted a number of clinical and ex vivo studies using imaging and spectrofluorometry. Our initial clinical imaging study revealed that the detection of a red background image instead of the red AF image increased the lesion-to-healthy tissue contrast by a factor of 2. This improvement has been implemented in an AFB device that is currently commercialised by the Richard Wolf Endoskope GmbH. In a seperate clinical imaging study we investigated the influence of the excitation wavelength on the AF contrast. Using a narrowband (6 nm FWHM) excitation around 410 nm resulted in a 1.5 times higher lesion-to-healthy tissue intensity contrast than observed with a comparable broadband (80 nm FWHM) excitation. A supplemental study showed that short wavelength blue backscattered light around 430 nm has the potential to discriminate true positive lesions (i.e. early neoplastic lesions detected positive with the AFB system) from false positive lesions (i.e. benign tissue changes detected positive with the AFB system). A spectrofluorometric ex vivo study was performed to gain insight on the mechanisms at the origin of these contrasts. Five principal mechanisms are discussed, namely changes of: (1) the fluorochrome's concentration, (2) the fluorochrome's metabolic status, (3) the fluorochrome's physico-chemical microenvironment, (4) the tissue architecture such as thickening of the epithelium, and (
Edoardo Charbon, Claudio Bruschini, Arin Can Ülkü, Yichen Feng