Bile duct cancer, or cholangiocarcinoma, is a prevalent liver cancer often diagnosed at advanced stages, leading to poor survival rates. Therefore, the development of a reliable early detection technique is urgently needed. Current imaging techniques lack the necessary accuracy to distinguish between dysplastic and benign biliary ducts. Endoscopic techniques, while capable of directly assessing the bile duct lining, often suffer from insufficient sampling. In this paper we discuss a novel endoscopic optical light scattering technique designed to evaluate the malignant potential of the bile duct. The technique employs an ultraminiature spatial gating fiber optic probe compatible with cholangioscopes and endoscopic retrograde cholangiopancreatography (ERCP) catheters. The miniature optical probe enables the detailed investigation of the internal cellular composition of the bile duct epithelium using light scattering spectroscopy (LSS) and also allows for the assessment of the phenotypic properties of the underlying connective tissue with diffuse reflectance spectroscopy (DRS). In a pilot in vivo double-blind prospective study involving 29 patients undergoing routine ERCP procedures, the technique detected malignant transformation with 97% accuracy. Our pilot study suggests that biliary duct pre-cancer can be identified non-invasively in vivo, offering a promising new avenue for early detection and intervention in bile duct cancer.
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