Fluorescence-labeled peptides that affinity bind to neoplastic mucsosa are promising for use as a specific contrast agent
in the detection of pre-malignant tissue in the esophagus. This method is can be used to identify expression of biological
markers associated with dysplasia on endoscopic imaging as a guide for biopsy and represents a novel method for the
early detection and prevention of cancer. We demonstrate the use of phage display to select affinity peptides and
identify the sequence "ASYNYDA" that binds with high target-to-background ratio to dysplastic esophageal mucosa
compared to that of intestinal metaplasia. Validation of preferential binding is demonstrated for neoplasia in the setting
of Barrett's esophagus. An optimal tradeoff between sensitivity and specificity of 82% and 85% was found at the
relative threshold of 0.60 with a target-to-background ratio of 1.81 and an area under the ROC curve of 0.87. Peptides are a
novel class of ligand for targeted detection of pre-malignant mucosa for purposes of screening and surveillance.
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