Piccolo project develops endoscope for colon cancer diagnosis

09 May 2017

New instrument from Horizon 2020 project will use OCT and MPT for high-resolution imaging.

A project funded under the EU Horizon 2020 program aims to develop a novel endoscope for the identification and diagnosis of colorectal cancer, the latest step in the use of optical technologies to tackle one of the world's predominant cancers.

Running for three years until December 2019, and involving nine European industrial and research partners led by Spain's Tecnalia Research & Innovation research center, the Piccolo project envisages an advanced endoscope instrument able to deliver high-resolution structural and functional imaging.

Crucially, the probe should assist with the detection of pre-cancerous polyps, and the determination of which polyps are likely to develop into malignancies and which are not. At present, an invasive colonoscopy remains the most common method to carry out such assessments, but the technique is known to either misdiagnose or fail to observe a substantial number of polyps.

The Piccolo endoscope will combine two modalities: optical coherence tomography (OCT), already a focus of interest for cancer diagnosis, and multi-photon tomography (MPT).

MPT is becoming increasingly important in the study of skin and dermal diseases, as techniques based on multi-photon interactions and the induction of second-harmonic generation can allow the stimulation of specific biogenic fluorophores in fluorescence imaging, without necessarily requiring additional staining or markers.

Spotting changes at the cellular level
The Piccolo team proposes combining OCT and MPT with novel "red-flag" fluorescence technology, for in vivo diagnosis of the areas of concern as well as supportive examinations after clinical decisions. By combining the structural information from OCT with the precise functional information from MPT, this endoscope will provide gastroenterologists with immediate identification of colorectal neoplastic lesions and facilitate accurate and reliable diagnostics.

It should also allow for accurate grading of different colon cancers, as well as assessment of the size of lesions and the key determination of their margins, all in situ.

"We hope that Piccolo will provide major benefits over traditional colonoscopy," commented Artzai Picon of Tecnalia. "By developing an advanced endoscope using both OCT and MPT, we will provide high-resolution structural and functional imaging, giving details of the changes occurring at the cellular level comparable to those obtained using traditional histological techniques."

The probe should therefore help clinicians avoid the need for tissue sampling and subsequent biopsies, offering a less invasive and more patient-friendly approach. In particular, the detection of multiple polyps in a patient normally leads at present to the removal of all of them, followed by microscopic tissue analysis, but Piccolo might allow a more flexible way to examine the tissues of concern.

"Removal of polyps which carry no malignant potential, termed hyperplastic polyps, and the subsequent costly histolopathological analysis might be avoided through the use of the Piccolo endoscope probe, which could allow image-based diagnosis without the need for tissue biopsies," noted Picon.

The project hopes to have refined its first prototype by the end of 2018, and has said that it believes clinical trials could be ready to begin during 2020.

Alongside Spain's Tecnalia, other Piccolo project partners include compatriots BIOEF and CCMIJU; German endoscope specialists Karl Storz; Italy's Light4tech and the European Laboratory for Non-Linear Spectoscopy (LENS); M Squared Lasers and Imperial College from the UK; and Ireland's Tyndall National Laboratory.