Chest
Volume 138, Issue 4, October 2010, Pages 984-988
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Optical Coherence Tomography as an Adjunct to Flexible Bronchoscopy in the Diagnosis of Lung Cancer: A Pilot Study

https://doi.org/10.1378/chest.10-0753Get rights and content

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.

Trial Registration: clinicaltrials.gov; Identifier: NCT01039311

Section snippets

Study Population

Subjects were enrolled at the University of Oklahoma Health Sciences Center from June 2009 to December 2009. Study inclusion criteria included subjects 18 to 99 years of age with the presence of an endobronchial mass seen on chest imaging and the need for flexible bronchoscopy with endobronchial biopsies. An arterial blood gas was obtained preprocedurally on all patients. Exclusion criteria included a Paco2 > 47 mm Hg, long-term oxygen therapy, unwillingness to undergo flexible bronchoscopy,

Results

Eight patients with endobronchial masses on chest imaging were screened during the study period. Five patients were found to be eligible and participated in the study. A single endobronchial mass was identified in each subject during flexible bronchoscopy. A total of 60 endobronchial OCT images and corresponding biopsy specimens were obtained from the five subjects: 30 from an endobronchial mass and 30 from areas of normal-appearing bronchial mucosa. A library of OCT images with their

Discussion

The objective of this pilot study was to determine if it is feasible to use conventional OCT imaging as an adjunct to flexible bronchoscopy in the evaluation of patients with suspected lung cancer. Although the use of OCT imaging during rigid bronchoscopy for tracheal lesions has been reported,8, 9 this is the first reported use of OCT imaging in the United States during flexible bronchoscopy for bronchial lesions. Our data show that OCT imaging can be used during flexible bronchoscopy to

Conclusion

Conventional OCT imaging during flexible bronchoscopy appears to be feasible in patients with endobronchial tumors. This is the first reported use of this technology during flexible bronchoscopy in the United States. OCT scan features of malignancy may include loss of normal landmarks in the bronchial epithelium and lamina propria. Further studies are needed to determine the diagnostic yield of OCT imaging in the evaluation of endobronchial lesions.

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributors: We thank Randall G. Michel, MD; Julie A. Stoner, PhD; and Paul V. Carlile, MD for their intellectual contributions to this study.

Additional Information: The e-Figures can be found in the Online Supplement at http://chestjournal.chestpubs.org/content/138/4/984/suppl/DC1.

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