Fernandes Susan, Williams Gareth, Williams Elvira, Ehrlich Katjana, Stone James, Finlayson Neil, Bradley Mark, Thomson Robert R, Akram Ahsan R, Dhaliwal Kevin
Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK.
Centre for Photonics and Photonic Materials, Dept of Physics, The University of Bath, Bath, UK.
Eur Respir J. 2021 Mar 25;57(3). doi: 10.1183/13993003.02537-2020. Print 2021 Mar.
Solitary pulmonary nodules (SPNs) are a clinical challenge, given there is no single clinical sign or radiological feature that definitively identifies a benign from a malignant SPN. The early detection of lung cancer has a huge impact on survival outcome. Consequently, there is great interest in the prompt diagnosis, and treatment of malignant SPNs. Current diagnostic pathways involve endobronchial/transthoracic tissue biopsies or radiological surveillance, which can be associated with suboptimal diagnostic yield, healthcare costs and patient anxiety. Cutting-edge technologies are needed to disrupt and improve, existing care pathways. Optical fibre-based techniques, which can be delivered the working channel of a bronchoscope or transthoracic needle, may deliver advanced diagnostic capabilities in patients with SPNs. Optical endomicroscopy, an autofluorescence-based imaging technique, demonstrates abnormal alveolar structure in SPNs Alternative optical fingerprinting approaches, such as time-resolved fluorescence spectroscopy and fluorescence-lifetime imaging microscopy, have shown promise in discriminating lung cancer from surrounding healthy tissue. Whilst fibre-based Raman spectroscopy has enabled real-time characterisation of SPNs Fibre-based technologies have the potential to enable characterisation and real-time microscopic imaging of SPNs, which could aid immediate treatment decisions in patients with SPNs. This review discusses advances in current imaging modalities for evaluating SPNs, including computed tomography (CT) and positron emission tomography-CT. It explores the emergence of optical fibre-based technologies, and discusses their potential role in patients with SPNs and suspected lung cancer.
孤立性肺结节（SPN）是一项临床挑战，因为没有单一的临床体征或放射学特征能够明确区分良性与恶性SPN。肺癌的早期检测对生存结果有巨大影响。因此，人们对恶性SPN的快速诊断和治疗极为关注。目前的诊断途径包括支气管内/经胸组织活检或放射学监测，这些可能与次优的诊断率、医疗成本及患者焦虑相关。需要前沿技术来打破并改善现有的治疗途径。基于光纤的技术可通过支气管镜或经胸针的工作通道进行操作，可能为SPN患者提供先进的诊断能力。光学内镜检查是一种基于自体荧光的成像技术，可显示SPN中的异常肺泡结构。其他光学指纹识别方法，如时间分辨荧光光谱法和荧光寿命成像显微镜，在区分肺癌与周围健康组织方面已显示出前景。虽然基于光纤的拉曼光谱能够对SPN进行实时表征，但基于光纤的技术有潜力实现SPN的表征和实时显微成像，这有助于为SPN患者做出即时治疗决策。本综述讨论了当前用于评估SPN的成像模式的进展，包括计算机断层扫描（CT）和正电子发射断层扫描-CT。探讨了基于光纤的技术的出现，并讨论了它们在SPN和疑似肺癌患者中的潜在作用。
