Division of Pulmonary/Critical Care Medicine, Oklahoma City Veterans Affairs Medical Center and University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104-5020, USA.
Chest. 2010 Oct;138(4):984-8. doi: 10.1378/chest.10-0753. Epub 2010 May 14.
Lung cancer is the leading cause of cancer-related deaths in the United States and the second most common type of cancer in both men and women. Optical coherence tomography (OCT) scanning can generate high-resolution cross-sectional images of complex, living tissues in real time. The objectives of this study were to determine the feasibility of using OCT imaging during flexible bronchoscopy and to preliminarily assess the ability of OCT imaging to distinguish an endobronchial malignancy from normal endobronchial mucosa. A Niris OCT probe was introduced into the airways of patients with an endobronchial mass during flexible bronchoscopy. An investigational device exemption was approved by the US Food and Drug Administration for the use of the OCT system in this study. Conventional OCT scans of an endobronchial mass and a control area of normal bronchial mucosa were performed to generate real-time images in each patient. Following OCT imaging, the same sites were biopsied for pathologic correlation. We report on the first five patients enrolled. A total of 60 OCT images with corresponding endobronchial biopsy specimens were obtained. The average procedure time was 29 min. The histopathologic diagnoses of the endobronchial masses included two small cell carcinomas, one squamous cell carcinoma, one adenocarcinoma, and one endobronchial schwannoma. Microstructures of normal bronchial mucosa, including epithelium and lamina propria, were identified with OCT imaging. OCT scan features of malignancy included loss of normal, identifiable microstructures and subepithelial "optical fracture" of tissues. All patients tolerated the endobronchial imaging well without complications. Preliminary results suggest that OCT imaging is a technically feasible adjunct to flexible bronchoscopy in the diagnosis of lung cancer. This is the first reported use of OCT to generate images of endobronchial neoplasms during flexible bronchoscopy in the United States. This technology may in the future provide a noninvasive "optical biopsy," which could potentially guide the bronchoscopist to areas for biopsy or even obviate the need for conventional lung biopsies.
clinicaltrials.gov; Identifier: NCT01039311.
肺癌是美国癌症相关死亡的主要原因，也是男性和女性中第二常见的癌症类型。光学相干断层扫描（OCT）扫描可以实时生成复杂、活体组织的高分辨率横截面图像。本研究的目的是确定在柔性支气管镜检查中使用 OCT 成像的可行性，并初步评估 OCT 成像区分支气管内恶性肿瘤与正常支气管黏膜的能力。在柔性支气管镜检查中，将 Niris OCT 探头引入气道内有支气管内肿块的患者中。美国食品和药物管理局批准了一项研究性器械豁免，允许在本研究中使用 OCT 系统。对每位患者进行支气管内肿块和正常支气管黏膜对照区的常规 OCT 扫描，以生成实时图像。OCT 成像后，对同一部位进行活检以进行病理相关性检查。我们报告了前 5 名入组患者的情况。共获得 60 张 OCT 图像和相应的支气管内活检标本。平均手术时间为 29 分钟。支气管内肿块的组织病理学诊断包括 2 例小细胞癌、1 例鳞状细胞癌、1 例腺癌和 1 例支气管内神经鞘瘤。OCT 成像可识别正常支气管黏膜的微观结构，包括上皮和固有层。恶性肿瘤的 OCT 扫描特征包括正常、可识别的微观结构丧失和组织的上皮下“光学断裂”。所有患者均能耐受支气管内成像，无并发症。初步结果表明，OCT 成像技术是一种在诊断肺癌方面对柔性支气管镜检查的补充，具有技术可行性。这是在美国首次报告使用 OCT 生成柔性支气管镜检查中支气管内肿瘤图像。这项技术将来可能提供一种非侵入性的“光学活检”，这可能有助于支气管镜医师确定活检部位，甚至可能避免常规肺活检的需要。
clinicaltrials.gov；标识符：NCT01039311。
